Dicetutors Language Classes Enrollment Form

Pupil’s Name:
[text* pupil-name]

Pupil’s School Grade:
[text* pupil-grade]

Pupil’s Age:
[number* pupil-age]

Subject Preference:
[checkbox* subject-preference use_label_element “Yoruba” “Igbo” “Hausa”]

Guardian/Parent’s Name:
[text* guardian-name]

No. of Children to be Enrolled:
[number* no-of-children]

Guardian/Parent’s Email:
[email* guardian-email]

Guardian/Parent’s Phone Number:
[tel* guardian-phone]

City:
[text* city]

State:
[text* state]

Country:
[text* country] [submit “Submit”]

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