Academic Edge: Tutoring sign up form

This sign up form is for 1-2 children. If you would like to sign up more than 2 children for tutoring with Academic Edge then you will need to fill out this form again.

PARENT / CAREGIVER DETAILS:

First name:

Last Name:

Email address:

Street Address:

Postal Address (if different from above):

Home Number (at least one land line please):

Work Number:

Mobile Number:

TUTORING AND STUDENT DETAILS:

Number of children for tutoring:


Childs Name:

Childs Mobile (if applicable):

Date of Birth:
of ,
School Level (years 1-13):

Wanting to:



Subject Area(s):




Second Childs Name:

Second Childs Mobile (if applicable):

Second Childs Date of Birth:
of ,
Second Childs School Level (years 1-13):

Second Child is Wanting to:



Second Childs Subject Area(s):




PAYMENT:

Terms: *

If the tutor deems it helpful, I am happy to pay for a practice book for my child(ren) to take home (up to $20.00):


I agree to give 24 hours notice of absence (with the exception of emergencies) in order to arrange an alternative time slot:


SAFETY AND SECURITY:

I give permission for refreshments for my child(ren) if required:


My child(ren) must stay at the centre until collected:


Does your child(ren) have any health issues we should be aware of?


If yes, please detail below:

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Page: Sign Up - Last Updated: 23rd February, 2012 | Site Map