STUDENT DETAILS

LESSON ACCESS/GOALS

KNOW YOUR CHILD

CLASS SCHEDULING

APPLICATION FORM FOR YOUNG LEARNERS (SS003)

Child's Name

Date of Birth

Child's Age:

Gender

Select your Country*

Select your city & 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?

Laptop/Desktop

Tablet

Smartphone

Do you have Zoom or Skype installed?

Yes, I do.

No, I don't. (We'll help you set it up)

LEARNING GOALS

Has your child learned English before?

Yes

If Yes, please share a bit more:

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

Speaking and confidence

Vocabulary

Reading

Writing

Listening skills

Conversation practice

Exam preparation (e.g. Cambridge, TOEFL Primary)

GET TO KNOW YOUR CHILD

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

Sports

Drawing

Games

Reading

Music

Movies/TV

Other:

How would you describe your child's personality?

Shy

Outgoing

Curious

Talkative

Quiet but focused

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)

Weekdays - Mornings

Weekdays - Afternoons

Weekdays - Evenings

Weekends - Mornings

Weekends - Afternoons

Weekends - Evenings

How many lessons per week are you considering?

1 lesson/week

2 lessons/week

3+ lessons/week

Not sure yet

CONSENT AND AGREEMENT

I give permission for my child to take online lessons with Smart Speak.

I agree to the Terms of Service and Code of Conduct.

I understand all lessons are conducted via Zoom, ClassIn, or Skype