InfinityED New Student Intake Form
This form is used to collect basic interest and general information regarding service needs, education level, availability, etc. 
* Indicates required question
Email *
Learner's Name 
If you are the guardian there will be a separate section for your personal information.
 *
Your answer
Learner's Phone Number 
If you are a guardian, you can provide your information in a below question.
Your answer
What Grade/ School Level is the Learner in? *
Your answer
Learner's Preferred Meeting Place? 
(Remote, at InfinityEd center, at home, hybrid)
 *
Required
Learner or Learner's Guardian? *
Required
Guardian/Parent/Other Inquirer Information
Guardian's Name
Your answer
Guardian's Contact Information
Please provide your phone number and best email to reach you at, if not one used to complete this form.
Your answer
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