Enrollment Questionnaire

Please complete this form once your student has been offered a placement in the studio. Thank you!

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Student Enrollment Profile

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Student Full Name: *

Student age: *

Student grade:

Student Birthday:

Student School: *

Parent 1 full name: *

Parent 2 full name:

Email address (Studio emails sent here): *

Secondary email (if you wish another recipient to receive Studio emails):

Primary Phone: *

Secondary Phone:

Primary phone: *

Home address (including zipcode): *

Has your student been diagnosed with any learning disorders and, if so, which one(s)?

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