T20 Education Services — Client Intake Form

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Family & Contact Details

Tell us about the family and who we should contact regarding tutoring sessions.

Primary Contact (Parent / Guardian)

First Name * Please enter your first name.

Last Name * Please enter your last name.

Relationship to Child * Please select a relationship.

Primary Phone * Please enter a phone number.

Email Address * Please enter a valid email address.

Alternative Phone

Home Address * Please enter your address.

Secondary Contact (optional)

First Name

Last Name

Relationship to Child

Phone

Email

How Did You Hear About Us?

Source

Referred by (if applicable)

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Child's Details

Information about the pupil who will be receiving tutoring.

Pupil Information

Child's First Name * Please enter the child's first name.

Child's Last Name * Please enter the child's last name.

Date of Birth * Please enter the child's date of birth.

Gender

Current School Year * Please select a year group.

First Language

Nationality

Ethnicity (optional)

Siblings Who May Also Require Tutoring (optional)

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School Information

Details about the child's current school and academic setting.

Current School

School Name * Please enter the school name.

School Type * Please select a school type.

County / Borough

School Address / Postcode

Form / Class

SENCO / Teacher Name (if relevant)

Academic Context

Curriculum / Exam Board

Academic Setting

Upcoming Exams / Assessments

Exam Date / Academic Year

Summary of Recent School Reports or Assessments

Are you happy for us to liaise with the school / SENCO if needed?

Yes

No

Please ask me first

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Subjects & Predicted Grades

Select the subjects the child needs support with and indicate current or predicted grades.

Subject Requirements

Select subjects below and set the current grade (if known) and the target grade for each.

Tutoring Goals & Focus

Primary Goal for Tutoring

Catch up on missed content

Build confidence

Exam preparation

Extension & stretch

11+ / Entrance exam

Homework support

SEN specialist support

Enrichment / Gifted & Talented

Current Concerns or Specific Weak Areas

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Interests & Personality

This helps us match the child with a tutor who can build rapport and make learning engaging.

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Scheduling & Preferences

Tell us when and how you'd like tutoring sessions to take place.

Delivery Format

Session Format

Online (video call)

In-person (home visit)

Either / No preference

Consent & Declaration

I confirm that I am the parent / legal guardian of the child named in this form and have authority to enrol them in tutoring services.

I am happy to receive occasional emails about T20 Education Services, resources, and special offers. (You can unsubscribe at any time.)

Full Name (as signature) * Please enter your full name as a signature.

Date

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Client Intake Form