New Student Tutoring Application Form
Please fill out this form to apply for Tutoring Sessions for your child.
Parent/Carer Full Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Parent
Carer
Guardian
Other please state
Address
*
Street Address
Street Address Line 2
City
County
Postcode
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child's Full Name
*
First Name
Last Name
Child's DOB
*
Child's School and Year Group
*
Emergency Contact 1 Name Relationship Contact Number
*
Emergency Contact 2 Name Relationship Contact Number
*
Does your child have any special educational needs or requirements?
*
Does your child have any medical needs?
*
Additional Comments
Tutor
Subjects
Tutoring Start Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Session Day and Time Session Frequency
Status
Provisions Plus+ in the Community Identification Numbers
*
Student ID
Client ID
Payment Agreement
By enrolling my child in the Provisions Plus+ Tutoring Programme, I understand and agree that: 1. Tuition is provided on a monthly rolling contract basis and will continue until cancelled by either party in accordance with the cancellation terms below. 2. An invoice will be issued monthly in advance for the upcoming month's tutoring sessions. 3. Full payment must be received before the start of the invoiced month to secure my child's place on the programme. 4. Failure to make payment by the due date may result in my child's place being suspended or withdrawn until payment has been received.
Yes
No
Cancellation and Notice Period
Should I wish to withdraw my child from the tutoring programme, I agree to provide a minimum of one week's written notice by email. Where less than one week's notice is provided, I understand that fees for sessions scheduled within the notice period remain payable. No refunds will be issued for missed sessions unless agreed at the discretion of Provisions Plus+.
Yes
No
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Application
Submit Application
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