Private Tutoring Intake Form (2025)
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 Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address (For Invoicing Purposes)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student
Student Name
*
First Name
Last Name
Student Gender
*
Female
Male
Non-binary
Prefer not to say
Date of Birth
*
-
Month
-
Day
Year
Year Level 2025
*
Please Select
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Subject (one subject per lesson)
*
English
Mathematics
NAPLAN Tutoring
Sounds-Write Intervention (Reading & Spelling)
Other
How many lessons per week?
*
1 Lesson
2 Lessons
3 Lessons
4 Lessons
Tutoring Goals (What outcomes are you looking for with tutoring? Are there specific topics or skills you'd like the lessons to focus on?)
*
Learning Needs (Please provide information about your child's learning needs and any additional details you would like me to know)
*
Device (e.g. laptop, desktop, apple pencil, touch screen, external keyboard with iPad etc.)
*
Additional Student/s
Student 2
Student Name
First Name
Last Name
Student Gender
Female
Male
Non-binary
Prefer not to say
Date of Birth
-
Month
-
Day
Year
Year Level 2025
Please Select
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Subject (one subject per lesson)
English
Mathematics
NAPLAN Tutoring
Sounds-Write Intervention (Reading & Spelling)
Other
How many lessons per week?
1 Lesson
2 Lessons
3 Lessons
4 Lessons
Tutoring Goals (What outcomes are you looking for with tutoring? Are there specific topics or skills you'd like the lessons to focus on?)
Learning Needs (Please provide information about your child's learning needs and any additional details you would like me to know)
Device (e.g. laptop, desktop, apple pencil, touch screen, external keyboard with iPad etc.)
Student 3
Student Name
First Name
Last Name
Student Gender
Female
Male
Non-binary
Prefer not to say
Date of Birth
-
Month
-
Day
Year
Year Level 2025
Please Select
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Subject (one subject per lesson)
English
Mathematics
NAPLAN Tutoring
Sounds-Write Intervention (Reading & Spelling)
Other
How many lessons per week?
1 Lesson
2 Lessons
3 Lessons
4 Lessons
Tutoring Goals (What outcomes are you looking for with tutoring? Are there specific topics or skills you'd like the lessons to focus on?)
Learning Needs (Please provide information about your child's learning needs and any additional details you would like me to know)
Device (e.g. laptop, desktop, apple pencil, touch screen, external keyboard with iPad etc.)
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Scheduling (if known)
Please select all available starting times to maximise your chance of securing a spot. Please be aware that times are in Australian Eastern Standard Time (AEST).
AFTER SCHOOL TUTORING (please select ALL possible starting times)
Monday 3:30pm
Monday 4:30pm
Monday 5:30pm
Monday 6:30pm
Tuesday 3:30pm
Tuesday 4:30pm
Tuesday 5:30pm
Tuesday 6:30pm
Wednesday 3:30pm
Wednesday 4:30pm
Wednesday 5:30pm
Wednesday 6:30pm
Thursday 3:30pm
Thursday 4:30pm
Thursday 5:30pm
Thursday 6:30pm
I do not know my schedule yet
HOMESCHOOL TUTORING (please select ALL possible times)
Monday Morning (9am - 12pm)
Monday Afternoon (12pm-3pm)
Tuesday Morning (9am - 12pm)
Tuesday Afternoon (12pm-3pm)
Wednesday Morning (9am - 12pm)
Wednesday Afternoon (12pm-3pm)
Thursday Morning (9am - 12pm)
Thursday Afternoon (12pm-3pm)
I do not know my schedule yet
Please specify your top 3 preferred tutoring times
Please include your most desirable days/times for tutoring and I will do my best to accommodate your preferences.
If you prefer a lesson length longer than 50 minutes, please include your preferred duration below.
Payment Method
Payment Method (weekly tutoring)
*
School Term Upfront Bundle - $95 per lesson ($85 per lesson for homeschoolers)
Fortnightly Payments - $105 per lesson ($95 per lesson for homeschoolers)
Agreement Confirmation
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 agree that GM Tutoring requires your commitment to all weekly tutoring lessons for the duration of QLD School Terms (excluding trial lessons). Cancellations with at least 24 hours' notice may be eligible for a make-up lesson. Please refer to the Terms and Conditions for full details.
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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