LanguageBird Enrollment Form
Smart bird! We can't wait to have you learn with us! Please note it may take 5-7 school days to get matched with an instructor.
Student Information
Student Full Name
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First Name
Last Name
Home Phone Number
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Cell Phone Number
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Student Email
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Confirmation Email
Address
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Street Address
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City
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Date of Birth
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Month
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Day
Year
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Sex
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Male
Female
Current School
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If not attending a school, please write "n/a"
High School Graduation Year
Required if student is in High School
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Parent Information
*Required if student is under the age of 18.
Parent Full Name
First Name
Last Name
Parent Email
Home Phone Number
Cell Phone Number
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Course Enrollment Information
Language:
*
French
German
Hebrew
Italian
Japanese
Mandarin
Spanish
Am. Sign Lang (ASL)
Arabic
Russian
Korean
Portuguese
English (ESL)
Greek
Choose Language
Course Level:
*
1
2
3
4
5
6 (Spanish ONLY)
Give us your best guess! Course Level (1-6)
Have you taken any courses or have prior experience with the language? Do you have any specific goals for learning 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 put 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?
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*This will help us match you with a teacher. Please put your time zone and am/pm.
When would you like to start?
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When would you like to start your lessons? (Note: 5-7 days required from enrollment to start date.)
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Month
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Day
Year
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Payment and Terms
Program Type:
*
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( X )
Full Year Course for Credit - Tuition:
$
2,275.00
Single Semester Course for Credit - Tuition:
$
1,250.00
Semester Options
Semester A - 12 Lessons
Semester B - 12 Lessons
Tutoring or Test Prep Lessons
$
510.00
Tutoring/Test Prep Lessons
6 Lessons
12 Lessons
18 Lessons
24 Lessons
Conversational Lessons
$
445.00
Conversation Lessons
6 Lessons
12 Lessons
18 Lessons
24 Lessons
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Confirmation
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Parent Signature
*
Required if student is under 18 years of age.
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How did you originally hear about LanguageBird?
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Lead Source
Lifecycle Stage
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