AMG Holiday Tuition Request Form

AMG Holiday Tuition Request for Year 2017/2018

Please fill out all the fields marked with an *
Student's Full Name

First NameLast Name
Birth Date

DayMonthYear
Gender
School
Form
e.g. Year 10 or Grade 10
Dates available for lessons in the following holiday periods
Summer 2017:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearStart Date
DayMonthYear
2 digit day, 2 digit month, 4 digit yearEnd Date
Autumn HT 2017:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearStart Date
DayMonthYear
2 digit day, 2 digit month, 4 digit yearEnd Date
Christmas 2017:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearStart Date
DayMonthYear
2 digit day, 2 digit month, 4 digit yearEnd Date
Spring HT 2018:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearStart Date
DayMonthYear
2 digit day, 2 digit month, 4 digit yearEnd Date
Easter 2018:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearStart Date
DayMonthYear
2 digit day, 2 digit month, 4 digit yearEnd Date
May HT 2018:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearStart Date
DayMonthYear
2 digit day, 2 digit month, 4 digit yearEnd Date
* Holiday tuition for the next academic year (2018/2019), please call us to obtain the booking form
Days or times when lessons definitely CANNOT be taken:
PARENT / GUARDIAN
Title
Name

First NameLast Name
Home Address

City

Country
Office Address

City

Country
I would prefer regular correspondence to be sent to
Invoice to (if not the parent, please specify):

Other
Email
example@example.com
Mobile Phone
Format: (000) 000-0000.
Phone Number
Format: (000) 000-0000.
Student's Mobile Phone
Format: (000) 000-0000.
Tuition Requirements

Please state which of the following exam board the student is using for each subject (AQA, Edexcel, OCR, IB (Higher or Standard level), CIE, HSC, VCE, other)

Rows	Subjects	Level of Exam	Module/Exam board	No. of hours per week	Total hours per subject
1
2
3
4
5

Preferred Time range (No selection means anytime is available)
Please state the book titles (esp. for English Literature) or any topics that need to be covered:
Lessons will be booked on a strictly first-come-first-served basis. To avoid disappointment, please ensure that you complete this form and return it to us as soon as possible. Our tuition fees range from $620/hour to $750/hour depending on student level and tutor requested. Once confirmed, lessons will be reserved for you absolutely, but confirmation indicates acceptance of the fact that fees will be chargeable even in the event of later cancellation.
I understand and accept the charges and cancellation policy.
For our full terms and conditions please click here
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AMG Holiday Tuition Request for Year 2017/2018