Tutoring Parent Questionnaire
Getting to Know Your Child
Parents Information
Parent / Guardian filling out this Questionnaire
*
Mrs.
Mr.
Ms.
Miss
Dr.
Prefix
First Name
Last Name
Relationship to Child
*
Mother
Father
Other
Email Address
*
example@example.com.au
Phone Number
*
Please enter a valid phone number.
Parent / Guardian 2
Mrs.
Mr.
Ms.
Miss
Dr.
Prefix
First Name
Last Name
Relationship to Child
Mother
Father
Other
Child's Information
Child's Name
*
First Name
Middle Name
Last Name
Your child's preferred name
If Different
Child's Date of Birth
*
/
Day
/
Month
Year
Date
School attended by your child
*
School year of your child
*
Please Select
Prep.
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
What siblings does your child have?
What friends does the child have?
Does your child have allergies, or is there other medical information we should know about?
What are your child's strengths (academic, behavioural, social, and emotional)?
Outside of school, what activities or interests does your child have?
My child approaches learning with: (tick all that apply)
enthusiasm
curiosity
confidence
negativity
reluctance
anxiety
positivity
fear
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My child is motivated by?
What would best help your child learn?
List up to 6 words that best describe your child’s character:
Does your child have any anxieties? If yes, please explain.
What upsets your child and what (if anything) causes them anxiety?
Does your child have any academic concerns or areas for improvement? If yes, please explain.
My child has difficulty with…
What behavioural, social skills and/or emotional skills would you like to see developed this year?
What would an ideal teacher do for your child?
What are your hopes for your child this year?
Is there anything else you want us to know about your child?
Do you have any questions or concerns?
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Name of person completing questionnaire
*
First Name
Last Name
Date
*
/
Day
/
Month
Year
Date
Signature
*
Submit
Submit
Should be Empty: