Name of Student Age Grade School Parent MotherFather Name of Parent Address Telephone Your Email Please indicate your preferred method of communication PhoneEmail Please indicate the best time to contact you Between 9:00-12:00Between 12:00-5:00 Please select the type of service TutoringOrthopédagogieSpecial Education (please specify in next section)Courses (please specify in next section) Veuillez préciser / Please specify Tutoring: FrenchTutoring: EnglishTutoring: Math (in French)Tutoring: Math (in English)OtherSpecial Education: Private sessions for studentSpecial Education: Private sessions for parent and/or familyCourse: Stratégies d'Étude 3e et 4e année (September 2025)Course: Stratégies d'Étude 5e et 6e année (September 2025)Course: Lecture 2e année (September 2025) Please indicate further information about your child ex: intervention plan, learning disorder, etc