STUDENT DETAILS

Child's Name

Child’s Age:

Date of Birth

Gender:

Country & Time Zone:

What language(s) does your child speak at home?

PARENT/GUARDIAN INFORMATION

Parent Name *

Email Address *

Phone Number (Optional)

LESSON ACCESS INFORMATION

What device will your child use for class?

Do you have Zoom or Skype installed?

LEARNING GOALS

Has your child learned English before?

If Yes, please share a bit more:

What do you hope your child will learn at Smart Speak?

GET TO KNOW YOUR CHILD

What are your child’s favorite things? (Check all that apply)

Other:

How would you describe your child’s personality?

Other:

Is there anything special we should know about your child?
(learning style, behavior notes, special interests, etc.)

CLASS SCHEDULING

When is your child usually free for lessons? (Your local time)

How many lessons per week are you considering?

CONSENT AND AGREEMENT