Parental / Guardian Consent Form

📋 [Business Name] 👤 Tutor: [Your Name] 📅 Date: [Date]

      This form must be completed by a parent or guardian before tutoring begins for any student under 18 years of age. It is required for safeguarding purposes and to ensure tutoring is appropriately tailored to your child's needs.
    

Section A — Student Details

Student's full name

Date of birth

School / college

Year group / exam year

Subject(s) to be tutored

Exam board (if applicable)

Section B — Parent / Guardian Details

Parent / guardian full name

Relationship to student

Contact telephone

Email address

Home address (if sessions are in-person)

Section C — Emergency Contact

Emergency contact name

Relationship to student

Emergency contact telephone

Alternative telephone

Section D — Medical and Learning Needs

Please disclose any medical conditions, learning differences, or special educational needs that may affect tutoring sessions. This information is held confidentially and will only be used to support your child's learning.

Medical conditions / allergies (if relevant)

Learning differences / SEND (e.g. dyslexia, ADHD, ASD)

Section E — Session Arrangements

Please confirm the intended session format:

In-person sessions at student's home or agreed location

Online sessions via video call (Zoom / Teams / Google Meet)

Both in-person and online

For online sessions: I confirm that a responsible adult will be present in the building during all sessions with my child.

Yes, I confirm

Section F — Consent Declarations

Please tick all that apply:

I consent to [Your Name] holding my child's personal data (name, school information, session notes) in compliance with UK GDPR, as described in the attached Privacy Notice.

I consent to the tutor taking brief session notes to support continuity of learning.

I consent to the tutor contacting my child directly via the agreed platform(s) for session-related communication. All other contact to be directed through me.

Photography / social media: I consent to anonymised progress comments being shared (e.g. "student achieved…") — no full names or images without separate written consent.

Do NOT consent to any social media or public mention of my child's progress.

DBS Disclosure: [Your Name] holds an Enhanced DBS Check (Disclosure and Barring Service). Disclosure number: [DBS Number — or "available on request"]. Issued: [DBS Issue Date].

Section G — Additional Information

Anything else the tutor should know?

Tutor

[Your Name]

Date

Parent / Guardian

Signed (full name)

Date