Hire Samuel Samson

Parent/Guardian Information

Full Name of Parent/Guardian *

Phone Number *

WhatsApp Number (if different)

Email Address *

Home Address *

Relationship to Student *

Mother Father Guardian Other

Full Name of Student *

Date of Birth *

Gender *

Male Female

Current School *

Class/Grade *

Any Learning Difficulties or Special Needs? *

Yes No

Learning Goals / Parent Expectations *

How did you hear about Tedufix Academy? *

Referral Social Media Website Flyer / Banner Other

I confirm that the information provided is accurate and agree to comply with Tedufix Academy's tutoring policies. *