After-School Tutoring Registration Form
Please note our After-School Tutoring will begin on September 2024.
Select After-School Programmes
*
Read and Spell Programme
Intensive Read & Spell Programme
Reading Comprehension Programme
Part-time Cognitive Enhancement Programme
Writing Programme
Maths Programme
Student Legal Name
*
First Name
Middle Name
Last Name
Student Preferred Name
*
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
Please Select
Male
Female
Registration for Year (Year 1 - Year 12)
*
Proposed Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Grade/Year (Indicate if British or American system)
*
Name of Current School
*
Had your child ever repeated a year/grade?
*
Yes
No
If yes, which year/ grade was repeated?
Where?
Has your child ever received Special Education or Learning Support?
*
Yes
No
If so, please provide details of extra help given and provide specialist reports
Is your child's first language English?
*
Yes
No
Parent / Guardian Information
Indicate primary caregiver: Mother / Father / Guardian / Other
*
Mother Information
Mother's Name
*
First Name
Last Name
Mother Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mother Work Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mother Email Address
*
example@example.com
Street Address
*
Street Address
P.O. Box
City
State / Province
Postal / Zip Code
Place of Employer
Profession
Father Information
Father's Name
*
First Name
Last Name
Father Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Father Work Number
Please enter a valid phone number.
Format: (000) 000-0000.
Father Email Address
*
example@example.com
Street Address
*
Street Address
P.O. Box
City
State / Province
Postal / Zip Code
Place of Employer
Profession
Student Release Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Relation
*
Please indicate if there is a court order restricting access to this child
*
Yes
No
If so, indicate individual's name
Additional Notes:
Parent Declaration
Parent / Guardian Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Continue
Continue
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