Short Course Booking Form

Your Details

As the representative of the school, please provide your details.

Teachers Full Name *

Please provide the full name of the teacher or staff member booking this course

Teachers Email Address *

Please provide your email address so that we can email you confirmation that the booking has been recieved

Phone Number

School *

Source of Funding Source of Funding

Students Details

Student First Name *

Student Last Name *

Student NSN Number *

Student Year Group *

Student Ethnicity Student Ethnicity

Course & Booking Details

What course would you like to book your student on?

Course *

ICE Cyber Security

ICE Cloud Technologies

CODE Programming

CODE Games

ICE - Cyber Security *

APRIL, WEEK 1 (April 15th - April 17th / 9am to 3pm)

APRIL, WEEK 2 (April 22nd - April 24th / 9am to 3pm)

JULY, WEEK 1 (July 8th - July 10th / 9am to 3pm)

JULY, WEEK 2 (July 15th - July 17th / 9am to 3pm)

ICE - Cloud Technologies *

APRIL, WEEK 1 (April 15th - April 17th / 9am to 3pm)

APRIL, WEEK 2 (April 22nd - April 24th / 9am to 3pm)

JULY, WEEK 1 (July 8th - July 10th / 9am to 3pm)

JULY, WEEK 2 (July 15th - July 17th / 9am to 3pm)

CODE - Programming *

APRIL, WEEK 2 (April 22nd - April 24th / 9am to 3pm)

JULY, WEEK 1 (July 8th - July 10th / 9am to 3pm)

JULY, WEEK 2 (July 15th - July 17th / 9am to 3pm)

CODE - Games *

APRIL, WEEK 1 (April 15th - April 17th / 9am to 3pm)

APRIL, WEEK 2 (April 22nd - April 24th / 9am to 3pm)

JULY, WEEK 1 (July 8th - July 10th / 9am to 3pm)

JULY, WEEK 2 (July 15th - July 17th / 9am to 3pm)

Other Information

Student Date of Birth

Student Mobile Number

Student Email Address

Does the student have their own device?

What type of operating system will the student be using?

Next of Kin Full Name:

Next of Kin Contact Number:

Health & Disability

Does your student live with the effects of a significant injury, long term illness, or physical / mental challenge that may affect your time here at Techtorium? The information you supply is confidential. This may include: Depression, anxiety, bi-polar, ADHD, ADD, Asperger’s, diabetes, dyslexia, hearing/sight impairment, epilepsy etc. If yes, please give us as much information as you can so we can assist when needed to support your students success.

Further Information

Please state the injury, long-term illness, or physical or mental challenge that would affect your student's time at Techtorium

Your Details

Students Details

Course & Booking Details

Other Information

Campus Details

Key Information

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