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

Other
Student Gender
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)
How many lessons per week?
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)
Comment (optional)
Terms and Conditions Agreement
Weekly Commitment
Communication Consent
Signature
Should be Empty:

Parent/Caregiver