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* 1. Your name / 您的姓名 

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* 2. Your son or daughter's name / 您孩子的姓名 （如果您是本人有兴趣学习英语，请略过）

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* 3. Your son or daughter's current age / 您孩子现在的年龄

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* 4. Your child's current English level / 您孩子现在的英语水平

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* 5. Your child's general availability for class / 您孩子何时会有空上课（大约一小时）

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* 6. Your contact information / 您的联系方式 （请写下您的电子邮件地址） 

Your information is stored according to E.I. Amplified privacy agreement automatically, and will comply with Canadian legal regulation regarding data security. / 您的信息受到E.I. Amplified个人信息保护协议保护，我们的信息安全协议遵从加拿大当地信息保护法案。

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* 7. Your contact information / 您的联系方式 （请写下您的微信号）

Your information is stored according to E.I. Amplified privacy agreement automatically, and will comply with Canadian legal regulation regarding data security. / 您的信息受到E.I. Amplified个人信息保护协议保护，我们的信息安全协议遵从加拿大当地信息保护法案。

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* 8. Thank you very much for your interest, an E.I. Amplified staff member will contact you shortly. What is your preferred means of contact? / 非常感谢您对我们项目的兴趣，我们的工作人员会很快跟您联系。请告诉我们您更希望我们通过那种联系方式联系您？

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