OA Tutors | Unlock Your Child's Potential

Section A: Pupil Information

Full Name

Date of Birth

Current School

Year Group

Section B: Parent/Guardian Information

Parent/Guardian Name(s)

Relationship to Child

Address

Primary Contact Number

Secondary Contact Number

Email Address

Emergency Contact Name & Number

Section C: Academic Information

Subjects Requested

Current Academic Level/Grades

Exam Preparation (e.g. 11+, GCSE, A-Level)

Strengths

Areas for Improvement

Learning Goals

Section D: Learning Profile

Preferred Learning Style (if known)

Visual Auditory Kinaesthetic Other:

Previous Tuition Experience

Yes No

If Yes, please provide details

Additional Notes on Behaviour, Motivation, or Study Habits

Section E: Special Requirements

Learning Difficulties/Conditions

Yes No

If Yes, please provide details

Medical Needs/Allergies

Accessibility Requirements

Section F: Tuition Arrangements

Tuition Mode

Online In-Person Group Private

Preferred Days/Times

Frequency of Sessions

Session Duration

Section G: Agreement & Consent

I confirm that the information provided is accurate to the best of my knowledge. I consent to tuition arrangements under the provider's safeguarding, data protection, and payment policies.

I agree to the terms and conditions

Parent/Guardian Signature

Date