Enrollment Form

LanguageBird Enrollment Form

Smart bird! We can't wait to have you learn with us!
Student Information
Student Full Name *

First Name Last Name
Home Phone Number *

Area Code Phone Number
Cell Phone Number *

Area Code Phone Number
Student Email *

Confirmation Email

Address *

Sex *

Male Female
Date of Birth *

Month Day Year
Date
High School *
Required if student is in High School
High School Graduation Year
Required if student is in High School
Skype ID:
Get it for free here: https://www.skype.com
Google Hangouts Gmail Address:
Get it for free here: https://hangouts.google.com/
Parent Information

*Required if student is under the age of 18.
Parent Full Name

First Name Last Name
Parent Email
Home Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
Course Information
Language? *
Choose your language option from the dropdown menu.
Course Level? *
Give us your best guess! Course Level (1-6)
Have you taken any courses or have prior experience with the language?
None is needed. We'd just like to know what you've done!
Do you have an IEP, 504 plan or need to request any learning accommodations?
High School Students: If we know, we can determine how we can help.
What is your first choice for day/s of the week and time would you like to take your lessons? *
*This will help us match you with a teacher. Please indicate your time zone and am/pm.
What is a second option for day/s of the week and time would you like to take your lessons? *
*This will help us match you with a teacher. Please indicate your time zone and am/pm.
When would you like to start? *
When would you like to start your lessons? (Note: 3-5 days required from enrollment to start date.) *

Month Day Year
Payment Information

Program Type: *

Full Year Course for Credit - Tuition: $ 2,197.00

Single Semester Course for Credit - Tuition: $ 1,188.00

Semester Options

Tutoring or Test Prep Lessons: $65-80/Session Free

Tutoring/Test Prep Lessons

Conversational Lessons: $55-75/Lesson Free

Conversation Lessons

LanguageBird Enrollment Form