Student Name?

Parent Name?

Best number to contact you at?

Do you have an idea of how much time you were looking for per week (ie: 1 hour per week, 6 hours a week)?

What is the student's availability (best days and times)?

How did you hear about us?

What subject(s) do they need help in and what grade level?

What are their current marks?

Where do they want to have their marks at?

Does the student have any learning disabilities?

In case your child's regular tutor is not available, would you like us to reschedule, or would you like us to contact you?

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