Smarter Bees Intake Form

Smarter Bees Intake Form
Welcome to Smarter Bees Educational Services

Let’s get buzzing! Please complete this form to enroll in tutoring or schedule consultation services
What brings you to the Smarter Bees hive today?
Parent/Guardian/Adult Name

First NameLast Name
Parent/Guardian/Adult Email Address
example@example.com
Parent/Guardian/Adult Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
City and ZIP Code

S

CityState / Province

Postal / ZIP Code
Agreement to Receive Buzz-Worthy Updates!
SMS Communication & Privacy Notice
By checking the box above, you consent to receive SMS (text message) communications from Smarter Bees, LLC regarding appointment reminders, scheduling updates, service-related information, or follow-ups. Message frequency varies. Message and data rates may apply. Your mobile number and message content will remain confidential and will never be shared or sold to third parties. You may opt out at any time by contacting Smarter Bees, LLC in writing.
Tutoring Information

Please complete one form per learner. The only exception is for our Buddy Bees Program, where two learners within one grade level and with similar goals may share a form. Otherwise, please submit a separate form for each learner. Thank you!
Learner Name

First NameLast Name
Buddy Bee Learner if Applicable

First NameLast Name
Learning Stage
Buddy Bee Learning Stage if applicable
Emergency Contact
Frequency
May we have your permission to use photos, learner work, or testimonials for educational or promotional purposes (e.g., website, flyers, or social media)? This information will not be used for any other purposes and will never be shared without your permission.
Learning and Engagement
Tutoring Needs
In-Person or Virtual Learning
What motivates you or your learner (s)? (For parents/guardians, please answer based on what motivates your child(ren).)
What do you or your learner(s) dislike or find challenging when it comes to learning? (If you're completing this for your child(ren), please answer based on what you've observed they struggle with.)
Are there any allergies or medical needs we should be aware of?
Are there any cultural or personal preferences we should consider?
Consultation Information
Current services we offer
Preferred Consultation Methods
Please briefly describe how we can help.
How did you hear about us?

Other
If you were referred by a current client or a member of your school’s personnel, please include their first and last name so we can thank them!
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Smarter Bees Intake Form

Welcome to Smarter Bees Educational Services

Tutoring Information

Learning and Engagement

Consultation Information