THE OOZONE Tutoring Intake Form

Tutoring Intake Form

Child's name

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent or Guardian E-mail

Name of parent or guardian

Cell number

Format: (000) 000-0000.

School Information: Current Grade Level Name of School

In what Subject(s) is help needed?

Why do YOU think your child is struggling?

Preferred location of tutoring?

Summer 2025 Scheduling: Good Days and Times:

Number of sessions per week?

Available to begin? *Summer Sessions start 6/10/2025*

Student's personality type and interests?

If you have any questions, please contact Omni at (704) 905-4732 or theoozonellc@gmail.com.

To best support your child’s learning needs, please upload or bring any of the following (if applicable):

IEP (Individualized Education Program)
School Assessments or Evaluations
Report Cards or Progress Reports
Teacher Notes or Recommendations

Any other relevant documents that may help us tailor tutoring sessions effectively
These materials allow us to understand your child’s strengths, needs, and goals, so we can personalize instruction and provide the most effective support.