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 Name Last Name
Birth Date *

Day Month Year
Gender *

Male Female
School
Form
e.g. Year 10 or Grade 10
Dates available for lessons in the following holiday periods *

Summer 2017 Spring HT 2018 Autumn HT 2017 Easter 2018 Christmas 2017 May HT 2018
Summer 2017:

Day Month Year
Start Date
Day Month Year
End Date
Autumn HT 2017:

Day Month Year
Start Date
Day Month Year
End Date
Christmas 2017:

Day Month Year
Start Date
Day Month Year
End Date
Spring HT 2018:

Day Month Year
Start Date
Day Month Year
End Date
Easter 2018:

Day Month Year
Start Date
Day Month Year
End Date
May HT 2018:

Day Month Year
Start Date
Day Month Year
End 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 Name Last Name
Home Address *

Country
Office Address

Country
I would prefer regular correspondence to be sent to

Home Office
Invoice to (if not the parent, please specify):

Parent
Email *
example@example.com
Mobile Phone *
Phone Number
Student's Mobile Phone
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)

	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)

9am to 1pm 1pm to 5pm 5pm to 8pm
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. *

Yes
For our full terms and conditions please click here
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AMG Holiday Tuition Request for Year 2017/2018