Spanish Private Tutoring - Detailed Registration Form

I would like to sign up for the following program:

FREE TRIAL CLASS (June-July, 2025)Mamaestra and me coachingNannyMaestraLanguage SittingMamaestra Play_DateLoritos, Spanish Immersion programSpecialized Spanish Courses for Older ChildrenPrivate tutoring older kidsInternational Family Immersion in Galapagos (not active yet)Level up for PreK to K CourseOther
Student Information
Student's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Have you or Has your child previously studied Spanish?

YesNo
Current Spanish proficiency level:

BasicIntermediateAdvancedAny experience
Learning Goals: What are your main goals for learning Spanish? (e.g., improve conversation skills, prepare for tests, etc.) or Are there specific topics or areas of interest your child would like to focus on?
Are there specific topics or areas of interest your child would like to focus on?
Are there any additional comments or questions you have for us?

YesNo
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

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Date
Signature

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Student Information