NEW STUDENT INTAKE FORM

[Company name]
Please complete one form per student. Everything you share here goes to
the tutor who works with your child and helps us plan the first session.

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1. PARENT / GUARDIAN

Full name: _______________________________________
Relationship to student: _________________________
Email: ___________________________________________
Mobile phone: ____________________________________
Preferred contact method: [email / phone / text]
Second parent/guardian (optional):
Name: ____________________  Email: _______________  Phone: ____________
Who should receive invoices and billing questions?
__________________________________________________


2. STUDENT

Full name: _______________________________________
Preferred name / pronunciation: __________________
Date of birth: ______________  Grade level: ______
School: __________________________________________
Sibling(s) also enrolling? [yes / no]
If yes, name(s): _________________________________


3. SUBJECT AND BACKGROUND

Subject(s) needed: _______________________________
Current course/level (e.g. Algebra II, AP Chem, SAT prep):
__________________________________________________
Current grade or most recent score in this subject: ______________
Has the student worked with a tutor before? [yes / no]
If yes, what worked and what didn't?
__________________________________________________
__________________________________________________


4. GOALS

What would make tutoring a success in the next 3 months? Be specific if
you can (a target grade, a test date, finishing a course with
confidence):
__________________________________________________
__________________________________________________
Any deadlines we should plan around (test dates, application deadlines,
end of term)?
__________________________________________________


5. LEARNING NOTES

Anything that helps a tutor teach your child well: attention span,
confidence level, what frustrates them, what motivates them, any
diagnosed learning difference you choose to share (optional):
__________________________________________________
__________________________________________________
__________________________________________________


6. AVAILABILITY

Preferred session length: [30 / 45 / 60 / 90] minutes
Sessions per week: __________
Format: [in person / online / either]

Mark all windows that work (we will confirm an exact slot):
            Mon    Tue    Wed    Thu    Fri    Sat    Sun
3-5pm       [ ]    [ ]    [ ]    [ ]    [ ]    [ ]    [ ]
5-7pm       [ ]    [ ]    [ ]    [ ]    [ ]    [ ]    [ ]
7-9pm       [ ]    [ ]    [ ]    [ ]    [ ]    [ ]    [ ]
Mornings    [ ]    [ ]    [ ]    [ ]    [ ]    [ ]    [ ]

Earliest start date: _____________
Any weeks you are away in the next 2 months? ______________________


7. LOGISTICS

How did you hear about us? _______________________
Emergency contact (name and phone), if different from above:
__________________________________________________
For online sessions: does the student have a quiet space, a device with
a camera, and reliable internet? [yes / no / notes: _______________]


8. CONSENT

[ ] I am the parent or legal guardian of the student named above and I
    authorize [Company name] to provide tutoring services.
[ ] I agree to the service agreement and cancellation policy provided
    with this form.
[ ] I consent to receiving scheduling and billing emails about this
    account.
[ ] Optional: I consent to occasional program updates and offers by
    email. I can withdraw this at any time.

Signature: _______________________________  Date: ___________