Rushmere Tao Independent Teen Coaching

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This form is ideally filled out by parent/guardian and learner together. Please read and respond to questions carefully, openly, and as accurately as possible. Any questions can be directed to:

learning-coaches@developingreallearners.org

Throughout this form the young person to be coached will be referred to as ‘the learner’. Learners should be aged between 10-19 years old.

In this section, please indicate the responsible adult who will be the main contact for us and a second adult to contact in case of emergencies. Please start by adding the email address of the parent/guardian who will be our main contact:

Email *

Name of Parent/Guardian who will be our first contact. *

Relationship to learner *

Mother

Father

Grandparent

Aunt/Uncle

Other:

Telephone/WhatsApp/Other

Note: we will only use this form of communication in the rare case of an emergency or if you indicate you prefer to use it for general communication.

Name of other Parent/Guardian who is legally responsible for the learner (Just in case two parent/guardians wish to communicate with us - so we know who we will hear from).

Email address of second responsible adult...

Relationship to learner

Mother

Father

Grandparent

Aunt/Uncle

Other:

Clear selection

Telephone/WhatsApp/Other

Note: we will only use this form of communication in the rare case of an emergency or if you indicate you prefer to use it for general communication.

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