Home Tutor Scheme Registration - Childhood Cancer Association

Step 1 of 3
Student details

Student name

First name

Last name

Student's date of birth

When was treatment completed?

Primary Contact Name

(Parent/Guardian)

First name

Last name

Address

Post code

Phone number

Email

Language other than English spoken at home

Step 2 of 3
Schooling Information

Enrolled school

How many days/week? (approx.)

Subject/s in which your child requires assistance

(if more than one subject, please list in order of priority)

Preference for tutoring

Face-to-face

Online

Either

Do you have a potential tutor in mind?

If you know of a suitable tutor, or your school can recommend one, who may be willing to tutor in your home please complete the details below. If no details are completed in this section, a private tutor will be sourced by the Childhood Cancer Association.

Tutor name

First Name

Last Name

Tutor phone number

How do you know this tutor?

PLEASE NOTE: Tutors must be a South Australian Registered Teacher or school employed SSO, a retired teacher with previous registration, or from a professional tutoring company.

When contacted by the Family Service team, tutors will need to submit the following documents:

ABN
Teacher’s Registration Certificate OR Teaching Authority Letter
RRHAN Certificate (Responding to Risks of Harm, Abuse and Neglect Training)
Working with Children Check

Step 3 of 3
Consent for the release of information

I/We give permission for the Childhood Cancer Association (CCA) to release information for the purposes of assisting my child’s education, and understand that all information will be treated with respect for the privacy of my child and myself. This may include, where relevant;

Information about my child’s tutoring, including the contact details of their tutor, being shared with Hospital Schools SA (HSSA) and/or other members of my child’s treating team. CCA, HSSA and the WCH work together to support your child’s schooling
Personal details (including your name, address and phone number, and your child’s name, D.O.B., grade and subjects in which they require assistance) being provided to a private tutor/tutoring company in order for a suitable tutor to be found, if required.

Consent agreement

I/We agree to the above

Name

(Parent/Guardian)

Signature

Date

Home Tutoring Registration Enquiry

Do you have a potential tutor in mind?

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