New Student Form

I am looking for 補習需求：*

1-on-1 High School Chemistry (Regular/Honors)1-on-1 AP Chemistry1-on-1 College Chemistry

Parent/Guardian 家長姓名*

First NameLast Name

Student Name 學生姓名*

First NameLast Name

Parent Email 家長郵箱*

example@example.com

Student Email 學生郵箱*

example@example.com

Student Phone Number 學生電話號碼*

Parent Phone Number 家長電話號碼*

Preferred Contact 首選聯絡方式：*

EmailPhone CallText MessageWeChat/WhatsApp

Desired length of lesson 課程時長：*

60 minutes ($50-70)90 minutes ($80-100)120 minutes ($100-130)

Message 其他備註

Please notify at least 24 hours ahead to cancel or reschedule. 若您需要取消或改約課程，請提前24小時告知我們，謝謝*

I agree to the 24 hour cancellation policy.

We accept the following forms of payments 接受的支付方式: PayPal, Venmo, and Zelle.*

I acknowledge and agree to the payment methods.

Contact 聯繫方式

Wechat: @chem-mschen

Student Information