Register your child

Please complete the form below if you are eligible and apply for the Tutoring Young Residents Programme:

Referral Code

Please only enter a code if you have been provided with one, otherwise leave this blank.

Are you a social housing resident? *

Yes

No / Not sure

Which housing association are you currently with? *

If your housing association is not listed, please select None / Other and specify below.

Student Details

First Name*

Last Name*

Gender*

Male

Female

Non-Binary

Your Child's Primary School*

Student Date of Birth*

Your Child's Year at School*

(From 1st September 2024 to 31st August 2025)

Parent Details

First Name*

Last Name*

Relationship to Student *

Postal Code

Address

Address Line 1*

Address Line 2

Town/City*

County*

Post Code*

Parent / Guardian Email Address*

Parent / Guardian Mobile*

Emergency Contact Details

Emergency Contact First Name*

Emergency Contact Last Name*

Emergency Contact Number

Please provide a different contact number for the emergency contact. The application will not go through if the number entered has already been provided in the form.

Emergency Contact's Relationship to Student *

Student Information

Has your child been diagnosed with a disability or learning disability?*

If your child has a disability or learning difficulty please include additional information so we know what support to provide. e.g. If your child has a statement, receives additional support at school. Enter 'none' if this does not apply.

Does your child have any allergies? *

If your child has an allergy / health condition that we should be aware of please give details here. e.g. If your child takes any medication Enter 'none' if this does not apply.

Does your child have any other relevant health conditions, which have not been listed above? *

Does your child have any dietary preferences? *

How is your child performing in maths?*

How is your child performing in English?*

How would you describe your child's attitude in the classroom and towards learning? *

Statement	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
My child has a positive attitude towards school.
My child likes learning new things.
My child is socially confident around peers.

Devices Available To Child

Laptop / Computer

Smartphone

Tablet

None

We ask this question as some of our programme delivery happens online. Please select all devices available at home.

How did you hear about TU?

Further Information

Please note that you may be requested to provide evidence of this.

Is your child eligible for free school meals?*

Yes

Were you or your child born outside of the UK?*

Yes

Are you eligible for housing benefit, council tax support or working tax credit?*

Yes

Is your household income under Â£35,000 a year?*

Yes

Does your child live in a single-parent household?*

Yes

What is your child's ethnic origin?*

White

Black or Black British

Asian or Asian British

Mixed

Other ethnic group

Prefer not to say

Please select the broad ethnic category which will then allow you to select your child's ethnic origin.

Is English your (parent) first language?*

Yes

Are languages other than English spoken in your household? *

Yes

Please note, we only need to know if the parent/carer speaks any language other than English - not the level of English proficiency.

Do you give your child permission to leave the tutoring session unaccompanied?

Would you be happy to receive our monthly parent newsletter?

Yes

We primarily use text and email for our general communication with parents and carers, but if you have a preference for how we communicate with you about individual matters, please let us know:*

Permissions

Do you give your child permission to attend after school tutoring?*

Yes

As part of our long-term impact measurement, we want to make sure that our pupils continue making amazing progress even once they've finished attending our lessons. After your child has finished our programme, we will contact you annually to see if they are still doing well and are making progress!

You can opt-out of this communication at any time once your child has left the programme.

I understand and consent to this communication*

During the Tutors United programme, we may sometimes wish to take photographs or video recordings of children during the lessons, either for our own records to show the results of the programme to funders, for use as part of our learning curriculum or inclusion in our promotional material such as our website or social media. Tutors United may invite an external photographer to the lessons to take official photographs, and the organisation may also invite the media in to take photographs for publication.

Children who do not have consent will be prevented from taking part in a range of activities during the programme. Parents will always be notified by text and email before filming and photography taking place and have rights to access the photos.

To comply with the Data Protection Act 1998 and the new General Data Protection Regulation (May 2018), we need to ask your consent before Tutors United record any images of your child. Given this, please read the statements below and then tick whether you consent to this or not.

We may use your child's photograph in Tutors United's reports and other publications we produce for promotional purposes.*

We may use your child's image on our website.*

We may record your child's image on video*

Your child's image may appear in the media.*

Your child's first name only may appear with the image in the media.*

Please tick here if you consent to ALL of the above statements

Click here to view Tutors United's Data Protection Policy

I have read and understand Tutors United's Data Protection Policy*

I give Tutors United permission to share any details in this form with the Housing Association partner for my programme and relevant partners as necessary for delivery/monitoring purposes.*

Relevant partners may include but are not limited to external evaluators and funders. We may send your information to the Housing Association partners to verify whether you are a resident and/or to fulfil their monitoring requirements, but this will not be for marketing purposes. All personal data will be stored and shared securely, as well as anonymised wherever possible. Please note, Tutors United will not share any additional personal information beyond what you've supplied above without your additional consent.

Typed Signature*

Date*

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