Study Space Form - Study Space

Name

First

Last

Student's age

Student’s school year group

Guardian’s email address

Guardian’s mobile number

Student's email address

Student’s mobile number

LEARNING REQUIREMENTS

What areas of learning does your child need support with?

What subjects would you like expert tutoring in?

Please provide feedback/ comments from your school that will help us understand the areas that the tutor needs to focus on.

What are your child’s strengths and weaknesses? Include academic, social, emotional, physical, hobbies, interests and rewards.

Do you require extra homework outside of the tutoring session?

Yes
No

Does your child have specific cultural or religious practices that we need to be respectful of during classes in the centre?

What other languages are spoken at home?

Will a parent be bringing your child to the centre and see the tutor for a handover, or will you prefer updates via email?

Is there anything else that we need to be aware of to make your learning experience even better?

STUDENT'S MEDICAL INFORMATION

Does your child suffer from anaphylaxis ?

Yes
No

Does your child suffer from asthma?

Yes
No

Does your child have any other medical conditions?

Yes
No

If yes to any of these questions please provide specific detail and also the treatment plan.

Does your child take any regular medication that we need to be aware of?

Yes
No

Emergency Contact 1 Name

First

Last

Emergency Contact 1 Phone Number

Emergency Contact Email

Emergency Contact 2 Name

First

Last

Emergency Contact 2 Phone Number

Emergency Contact 2 Email

Who does the child live with?

Incase of emergency Study Space will endeavour to contact Guardian 1, then Guardian 2. If Guardian 1 or Guardian 2 are uncontactable please provide 2 alternate Next of Kin contacts who can approve medical attention if a child requires it.

Next of Kin Name

First

Last

Next of Kin Phone Number

Relationship to child

Next of Kin Name 2

First

Last

Next of Kin 2 Phone Number

Relationship to child

Do you give permission for Study Space to use photos of your child for promotional and communication purposes via social media or on the website?

Yes
No

Do you give permission for Study Space to use photos of your child for staff training purposes?

Yes
No

Terms and Conditions

I Agree
I Disagree

PAYMENT AND CANCELLATION POLICY

Tutoring sessions are paid per term and are direct debited from your account. Our team will be in touch via phone to securely manage your bank details for payment.

We understand that unplanned situations can arise and you may need to reschedule your tuition session, we request a minimum 24 hour cancellation notification period.

A reminder that cancellations are only applicable for illness-based appointments where we can provide some flexibility depending on when tutors are available. We request that you commit to all lessons during the term, cancellations outside of illnesses will incur a cancellation fee.

Our tutors prepare tailored sessions before every student attends their class, please consider your allocated tutoring session before booking other appointments/ extra curricular activities, the opportunity to reschedule with tutors can be tricky once all tutoring sessions are locked in for the term.

Thank you for being a valued part of our tutoring centre, by having consistent learning sessions you will see your student learn to their fullest potential.

Thank you for choosing Study Space to assist with your child’s learning needs.

Please check that all details are correct before you submit the form. If any of the details change please contact us as soon as possible.