Learning Leaf: Student Consultation Form
In order to get started and best help your child, we will need some information on how your child is currently doing with his/her school work.
Student's Year in School
School Student Attends
Student's Date of Birth
Student's Phone Number
Please enter a valid phone number if they have one.
What subject(s) does the student need help with?
Street Address Line 2
State / Province
Postal / Zip Code
How did you hear about Learning Leaf?
Parent Phone Number
Please enter a valid phone number.
I have read and agree to the terms found at this link: http://www.mylearningleaf.com/terms/
What limitations on scheduling availability is there? Are there any times/days that they definitely cannot meet?
What are the student's strengths academically?
What are the student's strengths outside of academics?
Where does the student struggle in academics?
My child struggles with the following: (Select all that apply)
Multi-step math problems
Comments or additional information
Thank you for taking the time to fill out this important form. We look forward to working with your family. If you have any questions please ask below or contact us at firstname.lastname@example.org.
( X )
Registration fee to be applied to first session. Non-refundable. Never expires.
Credit Card Details
Credit Card Number
Should be Empty:
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