SJSCR TERM 3 Literacy Tutoring Intake Form

SJSCR TERM 3 Literacy Tutoring Intake Form – Pre- Primary to Grade 5

Please fill out the following information to help us understand your child's literacy needs.
Child's Details:
Full Name

First NameLast Name
Date of Birth:

MonthDayYear
Date
School Currently Attending:
Grade / Year Level
👉 Pre-Primary (Tuesday's 3.30pm - 4.15pm)
👉 Years 1–2 (Thursday's 3.30pm - 4.15pm)
👉 Years 3–5 (Thursday's 3.30pm - 4.15pm)

Tutoring sessions run thoughout the school terms only.

Term Fee is $110 per child to be paid upfront at the start of the school term.
For your child’s safety, please tell us about any allergies, intolerances, or medical conditions we should be aware of:
Parent/Guardian Information:
Name

First NameLast Name
Relationship to child:
Phone Number
Format: (000) 000-0000.
E-mail
This is the email address you will be invoiced to.
How did you hear about us?
Please Specify
Literacy Information:
Has your child received any formal literacy tutoring before?
If yes, please provide details:
What specific literacy areas would you like the tutoring to focus on?
(please specify):
Learning Preferences and Behavior
How does your child prefer to learn?

Other
(please specify):
Does your child have any learning difficultiesor conditions we should know? (e.g., dyslexia, ADHD)?
If yes, please provide details:
Additional Information
Please include any other information that maybe helpful for our Facilitators to know (e.g., learning goals, specific concerns, medical conditions, etc.):
TERM 3 Sessions –Tuesdays and Thursdays, weekly, from 3.30pm to 4.15pm at SJ Community Resource Centre, 2 Paterson Street Mundijong. Parents are welcome to stay and sit in an adjacent room or leave students and return to collect.
Should be Empty:

SJSCR TERM 3 Literacy Tutoring Intake Form – Pre- Primary to Grade 5

Literacy Information:

Learning Preferences and Behavior

Additional Information