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Tutoring Intake form

This form is created to collect information about your needs as a parent. Mr. L's is a subscription based tutoring service tailored for individuals needs and focus. Please email admin@tutorwithmrl.com available consultation times and we can set up a zoom meeting.

First name

Last name

Email

Phone Number

How would you prefer we contact you?

Email

Phone call

Student(s)' name(s)

Student(s)' Grade(s)

Looking for

Private One on one Tutoring

Group Tutoring (3 student min)

Frequency of sessions

Tutoring 1x a week

Tutoring 2x a week

Type of Tutoring

Math tutoring

Science Tutoring

Both Math and Science

Executive Functioning

Method of tutoring

In person Tutoring (library)

Online Tutoring via Zoom

Child's Availability

Email

Phone

How did you hear about us?

By signing this document, I acknowledge the information provided is factual and accurate. This is not a guarantee of services, many variables dictate whether tutoring can be provided to your child. Consultation can take place either in person or online and will last 10-15 minutes.

Signature

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