Private Tutoring Client Intake Form

Private Tutoring Client Intake Form

Thank you for choosing GM Tutoring! Please fill out the form below to start your child's learning journey with Gemma. I am looking forward to hearing from you!
Parent/Caregiver
Parent/Caregiver Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address (For Invoicing Purposes)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student
Student Name*

First NameLast Name
Student Year Level 2024*
Subject*

EnglishMathematicsReading & Spelling InterventionNAPLAN TutoringStudy Skills (Year 7)Other
Student Gender*

FemaleMaleNon-binaryPrefer not to say
Please provide information about your child's learning needs and any additional details you would like me to know
If you prefer a lesson length longer than 50 minutes, please specify your preferred duration below (I will contact you to arrange the rate).
Private Tutoring Availability (select all possible starting times)*

During School Hours on Monday-Thursday ($10 discount)Monday 3:30pmMonday 4:30pmMonday 5:30pmMonday 6:30pmMonday 7:30pmTuesday 3:30pmTuesday 4:30pmTuesday 5:30pmTuesday 6:30pmTuesday 7:30pmWednesday 3:30pmWednesday 4:30pmWednesday 5:30pmWednesday 6:30pmWednesday 7:30pmThursday 3:30pmThursday 4:30pmThursday 5:30pmThursday 6:30pmThursday 7:30pmI am interested in private tutoring, but do not see my preference here
How many lessons per week?*

1 Lesson2 Lessons3 Lessons4 Lessons
Please provide information on what device your child will use during tutoring lessons and any accessories (e.g. laptop, desktop, apple pencil, touch screen, external keyboard with iPad etc.). *Touch screen is recommended for Years 1-2.*
Payment Method
Payment Method (weekly tutoring)*

Trial: $80 per lesson10 Lesson Bundle: $90 per lesson, $900 upfrontFortnightly Payments: $100 per lesson, charged fortnightlyHomeschool Lessons: $80 per lesson (bundle)/ $90 per lesson (fortnightly payment)Longer lesson required; payment plan to be arranged
Comment (optional)
Terms and Conditions Agreement*

By clicking this box, you acknowledge that you understand and agree to all GM Tutoring Terms and Conditions which can be accessed at https://www.gmtutoring.com.au/terms-and-conditions. You acknowledge that you have fulfilled the technology requirements and have completed the equipment test located at https://app.learncube.com/en-gb/troubleshooter/#/
Weekly Commitment*

By clicking this box, you acknowledge and understand that GM Tutoring requires your commitment to weekly tutoring lessons for the duration of QLD School Terms (excluding trial lessons). Make-up lessons can be arranged with 48 hours notice, and a maximum of 2 make-up lessons per term.
Communication Consent*

By clicking this box, you consent to GM Tutoring contacting you via email and/or phone for service-related matters. You also agree to receive occasional marketing emails, with the option to unsubscribe at any time.
Signature*

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Private Tutoring Client Intake Form

Parent/Caregiver

Student

Payment Method