Register

Children Information

Name*

Age*

School Name

Parent/Guardian Details

Title*

First Name*

Surname *

Home Address*

Mobile Number*

Work Address

Does this child normally live at this address? *

Yes No

Email*

Does this person have parental responsibility? *

Yes No

Does anyone else have parental responsibility for this child? *

Yes No

Emergency Contact Details (please provide details of two people we can contact if we are unable to get hold of you).

Name*

Telephone*

Mobile Number*

Address*

Relationship to the child*

Child’s Doctor

Doctor's Name*

Address*

Telephone*

About Your Child

Please detail any additional/special needs your child has? *

Please detail any dietary requirements/food allergies? *

Please detail any additional/special needs your child has? *

Signature*

Date

Personal Information

Full Name*

Email*

Date of Birth*

Address*

Pin Code*

Daytime Contact Number*

Home Telephone Number*

Notice period, ordate when you would be available to start Work

Employment History (Please give details of your current or most recent employment first. Include paid and voluntary work.)

Start / End Date

Employer Name and Address

Jobtitle

Nature of work

Start / End Date

Employer Name and Address

Jobtitle

Nature of work

Start / End Date

Employer Name and Address

Jobtitle

Nature of work

Education, Training and Development

Start / End Date

University, College, Schoolor Training Establishment

Qualification or Course Details

Grade

Start / End Date

University, College, Schoolor Training Establishment

Qualification or Course Details

Grade

Start / End Date

University, College, Schoolor Training Establishment

Qualification or Course Details

Grade

Personal Statement (Please state why you think you are suitable for this job. Give examples where appropriate and ensure that you address the points covered in the job description. Continue on an additional sheet if necessary.)

Can we approach your referees prior to interview?

Yes No

I have read and understood the above statement. If I have any convictions, cautions or pending cases to declare I will supply details of them at the time of application to Smart Learning Centre at the address shown below: I further certify that the information contained on this application form is accurate and true.

Register Your Child

Tell us a little about your child and what support you need. We’ll get back to you within 1–2 working days.

Parent / Carer Details

Full name *

Please enter your full name.

Email address *

We’ll email you to confirm next steps.

Contact number *

UK mobile or landline.

Child Details

Child’s first name *

First name only.

Year group *

We tailor support to your child’s year.

What do you need support with? *

Select one or more.

Tuition (Maths / English / Science)

Coding for Children

Childcare (After-school / Weekends)

Tip: Not sure what to choose? Select “Tuition” and write a short note below.

Preferred contact method *

Phone

Anything else we should know? (Optional)

Please avoid sharing detailed medical information here. We can discuss support needs safely after we contact you.

By submitting this form, you confirm you are the parent/carer and the information provided is accurate.

Register Your Child

Tutor Registration (Expression of Interest)

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Contact Info

I am a Parent

I am a Teacher

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Contact Info

How do you want to Signup?

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