Sign-Up Contact form – Nkosi Private Tutor

Congratulations on making the initiative to get your child the best help they can get.

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Who am I speaking to? *

Parent
Student (18 and under)

Parent / Guardian Required

Hey there! 👋 Just a heads up...

If you're under 19, we need your parent or guardian to help out with this form. It's just one of those legal things we have to follow.

Not with your parent/guardian right now? No worries!
- Take a break and chat with them about this
- Come back together when you're ready

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Alright, First Things First. Which Package Would You Like to Opt For?

Individual Once-Off Lesson
Individual Block Bookings of 1 Month or More
Once-Off Group Lessons (2 or More People)
Group Block Bookings of 1 Month or More

(Block bookings require a minimum of 4 hours per month)

Great, Now for Your Parental Details

Name (Parent) *

First

Last

Preferred title

Phone Number *

Email *

And What's Your Relationship to the Student?

Where Are You Based?

No need for your full address, just your suburb and city.

Almost there, now for student/s details

Number of students

Name (Student)

Subject They Need Help For

Mathematics
Physical Sciences
Both

Grade / Level

Curriculum

Name (2nd Student)

Subject They Need Help For (2nd Student)

Mathematics
Physical Sciences
Both

Grade / Level (2nd Student)

Curriculum (2nd Student)

Name (3rd Student)

Subject They Need Help For (3rd Student)

Mathematics
Physical Sciences
Both

Grade / Level (3rd Student)

Curriculum (3rd Student)

Name (4th Student)

Subject They Need Help For (4th Student)

Mathematics
Physical Sciences
Both Mathematics and Physical Sciences

Grade / Level (4th Student)

Curriculum (4th Student)

Reason for Getting a Tutor

What is your specific reason for requesting a tutor? For example, were you referred to me by your child's teacher? Has there been a sudden decline in marks? Etc

Any Additional Comments?

Is there any additional information you want to share pertaining to the child?

How Do You Prefer To Be Contacted? *

Phone
Email
Whatsapp Chat
iMessage

Name

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