Student Intake Form

Welcome to Kaizen Education Services

Please complete the following information in preparation for our intake session. We look forward to helping your child master their executive functioning skills to tackle life's many challenges. Thank you.

Primary parent / guardian

First name *

Last name *

Your email * Your phone number *

Best number to reach you at.

Your date of birth

Age

Sign me up for email tips, resources and early access to workshops and events. We won't spam you and you can unsubscribe anytime. How did you hear about Kaizen Education Services? *

Other parents / guardians

Add any additional parents or guardians (step-parents included). Optional.

Student information

Complete this for your child. If you are enrolling more than one child, use "Add another child" at the bottom.

Empowering Brains for Learning and Life

Kaizen Education Services, Calgary, Alberta, Canada.
Educational coaching, not medical or clinical care.