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

SJSCR 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: *
Pre-Primary (Ages 4–5) 3 SPOTS AVAILABLEYears 1 - 2 1 SPOT AVAILABLEYears 3–5 2 SPOTS AVAILABLEPlace me on the waitlist for Term 3
👉 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.
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:
NoYes
If yes, please provide details:
ReadingWritingSpellingPhonicsComprehensionGrammar
(please specify):
Learning Preferences and Behavior
Visual (pictures, diagrams)Auditory (hearing instructions)Kinesthetic (hands-on activities)Other
(please specify):
YesNo
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 1 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.
Term 1 Dates:
- Tuesday 03/02/2026 (Pre-primary Class Only)
- Tuesday 10/02/2026 (Pre-primary Class Only)
- Tuesday 17/02/2026 (Pre-primary Class Only)
- Tuesday 24/02/2026 (Pre-primary Class Only)
- Tuesday 03/03/2026 (Pre-primary Class Only)
- Tuesday 10/03/2026 (Pre-primary Class Only)
- Tuesday 17/03/2026 (Pre-primary Class Only)
- Tuesday 24/03/2026 (Pre-primary Class Only)
- Tuesday 31/03/2026 (Pre-primary Class Only)
- Thursday 05/02/2026 (2x Sessions - Years 1–2 & 3-5)
- Thursday 12/02/2026 (2x Sessions - Years 1–2 & 3-5)
- Thursday 19/02/2026 (2x Sessions - Years 1–2 & 3-5)
- Thursday 26/02/2026 (2x Sessions - Years 1–2 & 3-5)
- Thursday 05/03/2026 (2x Sessions - Years 1–2 & 3-5)
- Thursday 12/03/2026 (2x Sessions - Years 1–2 & 3-5)
- Thursday 19/03/2026 (2x Sessions - Years 1–2 & 3-5)
- Thursday 26/03/2026 (2x Sessions - Years 1–2 & 3-5)
- Thursday 02/04/2026 (2x Sessions - Years 1–2 & 3-5)
Should be Empty:

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

Literacy Information:

Learning Preferences and Behavior

Additional Information

Term 1 Dates: