Tuition Enrolment Form

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Education Provider Details

Referrer Details

Referrer Contact Details:

Parent/Carer Details 1

Parent/Carer Contact Details:

Parent/Carer Details 2

Parent/Carer Contact Details:

Student Details

Student Gender:
SEND / Disability:
If yes; please highlight:

Student Behaviour Summary:

Social Services Support

Does the student have a child protection plan?
Does the student have a CIN plan?
Is the student looked after (LAC)?

Academic Attainment

KS2 SATS

KS3 SATS

Please include: (Subject/s, Number of Hours per week, preferred day and time of tuition).

Academic Attainment

KS2 SATS

KS3 SATS

Risk Assessment Form

CONFIDENTIAL

Risks identified – Location Premises

Is the address known to police?
Are the premises isolated?
Do person/persons at the address have a history of violence, aggressive behaviour, or domestic violence?
Do person/persons at the address have a history of allegations against professionals
Are there potentially dangerous animals or pets at the premises?

Action Plan

Tuition to take place at kitchen table
Kitchen surfaces to be free of items that could cause harm (e.g., hot water in kettle, saucepans/iron, knives/knife block)
Tutor to sit by kitchen door with Pupil sitting opposite and behind the table
Kitchen door to be kept open
Front door to be kept unlocked

Useful information (E.g., location of key documents, network contact details)

Risk assessment shared and agreed

Nominated Person to Authorise Invoice:

Authorized Person Contact Details:

Terms & Conditions