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Part 1: Student particulars
*
Indicates required field
Student's Full Name
*
DOB
*
Gender
*
Female
Male
Other
School
*
Year/Form Level
*
Exam Pathway
*
NCEA
Cambridge
Other
Tuition Subjects Requested
*
If other then please specify :
*
Preferred Method
*
Centre-based
Online
Parent's Name
*
Postal address
*
Family Email Address
*
Work email address
*
Parent's Mobile number
*
Student's Mobile number
*
Part 2 : Any learning Preferences/Diagnosis
Choose
*
Dyslexia
Dyspraxia
Dyscalculia
Visual Processing Disorder
Auditory Processing Disorder
None
Other
If box ticked please add extra information
*
Part 3 : Any other areas of concern
Choose
*
Attention/Focus
Following Instructions
Language
Organizational difficulties
Handwriting/fine motor difficulties
None
Other
If box ticked please add extra information
*
Part 4 : Any Health/Medical issues ?
Choose
*
Eyesight : vision
Hearing APD/Hearing aids
Allergies
Sensory issues
ADHD (In)
ADHD (Hyp)
Co-ordination
Medical
None
Other
If box ticked please add extra information
*
Part 5 : Previous Assistance at School
Choose
*
RTLB
RTLiT
Writing group-school
Peer tutoring-school
Gifted and Talented group
Mathematics support
Private Tutoring
Reader/WriterNumber works
Kip McGrath
ESOL
Reading support
Kumon
SPELD
Social skills group
Use of Laptop/Netbook etc
Speech Therapy
Occupational therapy
Physiothearpy
Other
Other information you would like to add
*
Part 6 : Information Particulars
How did you find out about KTL tuition ?
*
Friend/Work Colleague
School recommendation
Brochure
Internet Search
Other
If "Friend/Work Colleague" box ticked then please provide their name or extra information
*
If you would like to receive Kidz Therapy/KTL Tuition News from time to time
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Please read the Terms and Conditions carefully.
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I have read and agree to the Terms and Conditions. Please ask for clarification of any points you are unsure of. This document is issued on 06/02/2021 and supersedes any previous terms and conditions issued by KTL Tuition.
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Home
About Us
About KTL
>
What We Do
Our Team
>
Teachers
Tutors
Tuition Fees
Testimonials
FREE eBook
Benefits of Tutoring
Blogs & News
Subjects
Mathematics
English
Other Subjects
Study Skills
Assessments
Registration Forms
Workshop Registration
Tuition Registration Form
Free Consultation
Work at KTL Tuition
Contact Us
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