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Student Registration Form

Classroom Interaction

We’re so glad you’re here and we appreciate you choosing us to support your child’s learning journey. This registration form helps us get to know your child as a learner, understand your goals, and gather important information to create a personalized support plan from the very first session.

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Please share details about your student's academic experiences, strengths, challenges, and areas where they would benefit from support. Your responses will help us prepare for meaningful and effective coaching from the very first session.

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Once your registration is complete and we have your preferred email address, we will send recurring calendar invitations for your sessions. Each invitation will include the Zoom meeting information, keeping everything organized and easily accessible in one place.

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Thank you for taking the time to share this information. We look forward to partnering with you!

Student Information

Birthday
Month
Day
Year
Grade Level of Student(s)

Consider:

What would the student be doing differently day-to-day?

What skills, habits, or strategies would they like to develop?

What would be different for you?

Does the student currently receive any academic or learning supports?

To help us create an effective, personalized learning plan, we ask that you share any of the documents listed below.:


• Any assessments completed

• Recent report cards

• Standardized test scores

• Teacher's comments or recommendations

• IEP, 504 Plan, or accommodation documentation (if applicable)

If available, please share the parent and/or student portal login information (website, username, and password). Access allows us to monitor assignments, grades, and teacher or professor feedback so we can provide timely support.


Primary Contact

Please provide the contact information for the person who should receive communications regarding scheduling, billing, and progress updates. This could be a parent, a guardian, or the student.

Multi-line address
Preferred Methods of Contact

Additional Contact

If you'd like to add another parent, guardian, or emergency contact, please provide their information below.

Multi-line address

Billing & Payment Information

Please review the following information and provide your preferences so we can ensure easy and timely billing.


You can send payment using any of the methods below:

Zelle: (347) 369-2999

Venmo: @Learning-Edventures-Inc

Apple Pay: (347) 369-2999

Cash App: $LearningEdventures

PayPal: @LearningEdventures


Be sure to include your child’s name, date of session, and/or invoice number in the payment notes.

Primary Contact for Scheduling & Billing
Primary Contact for Scheduling & Billing
Preferred Payment Method

How Did You Hear About Us?

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