This form should take approximately 5–15 minutes to complete.

It helps me build a broad profile of your child so I can plan and deliver high-quality, personalised sessions.

If you're unsure about any question or don’t have the information, feel free to leave it blank.

All information provided will remain confidential and will only be shared if required by law or safeguarding authorities.

Parent/carer information

First name

Last name

Email

Address

Phone

Relationship to the child

Child's Information

Full name

Preferred name

Age / Date of birth

Religion (OPTIONAL)

Nationality

First language

I know these languages

School Year

Favourite toys, characters, games, songs/music artists

Dislikes, things afraid of

Family members/Special people/Pets

Other information that will help me to provide tutoring to them

Learning needs

What subjects or areas does your child need support with? (e.g., phonics, early reading, handwriting, maths, confidence-building)

Are there any SEN, EAL, or other additional needs to be aware of?

Are you currently receiving support from any specialists or professionals for these additional needs? If so, please let us know who is involved (e.g., speech therapist, SENCO, educational psychologist, etc.).

Has your child taken any recognised English language exams? (For example: Cambridge Young Learners, IELTs 16+, A1 Movers, A2 Flyers,Cambridge English.) If yes, please list the exams and scores (if known).

Tutoring

What would you like your child to achieve through tutoring?

Preferred Days/Times for Sessions

Consents

Video recording

I give permission for my child / myself to appear on video and use audio during live online tutoring sessions via secure platforms such as Zoom, Google Meet, or similar.

Do you allow Charley King to record the sessions for the following purposes;

Yes, for the purpose of reviewing and reinforcing the lesson to support and strengthen learning

Yes, for promotional / marketing use

Yes, for Charley King to watch for areas of improvement / quality for Professional development to show continual Professional Development (CPD)

NO, I DO NOT ALLOW RECORDING

Use of photos/screenshots of child and/or their learning activities

Do you give permission for Charley King to use photographs or screenshots of your child and/or their work or learning activities?

Yes, for promotional / marketing use

Yes, for Charley King to watch for areas of improvement / quality for Professional development to show continual Professional Development (CPD)

I DO NOT ALLOW USE OF PHOTOS AT ALL

Agreements

Safeguarding

I understand that Charley Louise King does not currently hold an Enhanced DBS check, as she is a sole trader and is not eligible to apply for one independently.

In line with her safeguarding policy, I agree that a parent, guardian, or responsible adult will be present during all tutoring sessions involving a child under 18, whether sessions take place in person or online.

I understand that my personal data will be collected and stored securely by Charley King for the purposes of delivering tutoring services and communication only. It will not be shared with third parties.

Online sessions and material

I consent to the use of reputable online platforms, tools, and educational websites (e.g., interactive games, learning apps, screen-sharing tools) as part of the tutoring experience. All tools will be age-appropriate and safe.

I understand that it is my responsibility to ensure my child / I have access to a working internet connection and a suitable device for online sessions.

I agree to assist my child if needed during sessions (particularly for early years learners who may need help with devices or activities).

Communication

I give permission for Charley King to contact me via email, phone, or messaging for matters relating to sessions, progress, scheduling, or general updates.

Email

Phone Call

SMS/Text

Do not contact outside of sessions

Registration fee and payments

I agree to pay the £12.00 registration/set up fee

I acknowledge that 24 hours’ notice is required to cancel or reschedule a session. Cancellations with less notice may not be refunded.

Signature

Signature field is empty.