Trial Lesson Request

Trial Lesson Request Form

Thank you for your interest in LanguageBird! We would love to have you see what a lesson with LanguageBird is all about. Please fill out the following form and indicate the date/time you'd like to have your 30 minute trial lesson.
Student Information
Student Full Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Student Email *

Confirmation Email
Gender *

Male Female
Date of Birth *

Month Day Year
Date Date Picker Icon

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Country
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 Please be sure to establish your account and test it prior to your lesson time in order to be ready at your appointment time to meet your instructor.
Google Hangouts Gmail Address:
Get it for free here: https://hangouts.google.com/ Please be sure to establish your account and test it prior to your lesson time in order to be ready at your appointment time to meet your instructor.
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.
Parent Information

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

First Name Last Name
Parent Email
Phone

Area Code Phone Number
Lesson Type Information
Language? *
Choose your language option from the dropdown menu.
Course Level? *
Give us your best guess! Course Level (1-6)
We need to know when to schedule your 30 minute trial lesson. Please list here 2 or 3 dates, times (am/pm). *
*This will help us match you with a teacher. Please indicate your time zone and am/pm.
Time Zone? *
When would you like to start? *
Parent Signature *

Required if student is under 18 years of age. Clear
How did you originally hear about LanguageBird? *
Referral Code
If you have a referral card, type the code from the card into the space above.
NOTE: An instructor will confirm a lesson time within a few days of your submission of this trial lesson request.
Should be Empty:

Trial Lesson Request Form