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Student Last Name *

Student First Name *

Sex *

Date of birth *

School *

Would you like to know more about our STEM Programs *

Structure *

Select School Year *

Choose Subject *

Name of subject

Logic test *

Select Subjects

English
Maths

Select Subjects

English
Maths
Science
Biology
Economics
Chemistry
Business Studies
Physics
Legal Studies
Investigating Science
Modern History & Ancient History
Other

Date / Time *

Date

Time

Parent First Name *

Parent Last Name *

Email *

Address *

Suburb *

State *

Postcode *

Contact Number

Has Student had tutoring before ? *

If Yes, Name of Coaching Center

Is there a Medical Alert for the Student? *

If Yes, Please specify Medical Condition

Special Needs

Does your Child have ?

Autism
Behaviour Disorder
Hearing impairment
Intellectual disability
Language Disorder
Mental Health Issues
ADD/ADHC
Vision Impairment
Other (please specify)

Has your child ever seen?

Behavioural optometrist
Audiologist
Speech pathologist
Educational psychologist
paediatrician
occupational therapist
psychologist
Vision Impairment
Other Specialist (Please specify)

Primary Family Emergency Contacts

Name *

Relationship *

Contact Number *

Language Spoken *

(If English Write "E")

Provide Detailed Information About The Challenges Faced By Your Child *

You agree that you have read and understood all the terms of agreement.

You agree that you have read and understood all the terms of agreement below. *

Attendance: Students are expected to attend all their weekly tutorial classes during the scheduled time and day in which they have been enrolled in. The minimum enrolment period is ONE complete term and Disenrollment cannot be made during this period, nor will refunds be given under ANY circumstance.

Refund Policy / Outstanding payments: No credits or refunds will be provided under any circumstances.

Commitment:Upon the student enrolling and receiving our invoice, you are required to make full payment for one complete academic term before the first week of that term.

Absenteeism: 24 hours’ notice must be given prior to cancellation. Make up lessons will be organised during that week. Classes will not be carried onto the next term.

Termination of tutoring: After families have left Sprouts Academy, we will occasionally reach out to families to let them know of tips or ideas to help them in the long-term, or to offer them their place back after they have left for a while in case, they need it.

Code of Conduct: In an event where the parent/client engages with any of Sprouts Academy’s teacher directly/indirectly, without Sprouts Academy’s written consent, Sprouts Academy has the right to prosecute to the full extent of the law for any damages and losses.

External Examination Results: Sprouts Academy requests its students, to provide school examination and assessment results, achievement certificate, HSC results and photographs by phone and email.

Photography & Videos:

Sprouts Academy may take photos or videos of students whilst tutoring for promotional, reporting and communication purposes.

Occasionally we will share group photos, individual student photos or videos on our social media and other advertising platform.

Personal Information: All personal details are kept confidential, changes to such information must be provided as soon as possible. Inaccurate or incomplete information being provided intentionally may result in the non-acceptance of an enrolment or cancellation of an existing enrolment.

Declaration: I hereby, declare that all the information provided to Sprouts Academy in this application is true and correct. I understand that the purposeful giving of false, misleading or incomplete information may lead to the refusal of acceptance or cancellation of enrolment. I understand the fees and their structure as explained to me. I understand the cancellation and absenteeism policy. I agree to abide by Sprouts Academy rules and regulations.

Date *

Signature *

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