Acerox Youth Intake | Parent + Child Questionnaire

Eligibility and who is participating

We need to know whether this is a parent-guided intake or an adult student intake.

Student age *

Grade level or current stage

Who is completing this questionnaire? *

Parent/guardian + child together
Required for minors under 18.

Student alone
Allowed only if the student is 18 or older.

For students under 18, parent + child together is required.

Who will make the final purchase/setup decision?

Parent or guardian information

Skip-free for 18+ students, but still allowed if a parent is involved.

Parent/guardian full name

Relationship to student

Parent/guardian email

Parent/guardian phone

Why are you exploring this for your child right now?

What would success look like for you as a parent in the next 90 days?

Which concerns matter most to you?

Overreliance on AI instead of thinking

Privacy and sensitive information

Cheating or unhealthy academic shortcuts

Distraction, inconsistency, or lack of follow-through

Online safety, manipulation, or harmful content

No major concern, mostly focused on growth and capability

Student profile

This is how we personalize examples, projects, pacing, and coaching style.

Student first name *

Timezone *

What 3 to 5 things is the student most into right now? *

What does the student already use AI for, if anything?

Technology comfort level *

Coding experience

How does the student learn best? *

Short explanations

Examples first

Step-by-step practice

Discussion and reflection

Challenge mode

Goals, projects, and starting direction

We want the first 30 to 90 days to feel useful, practical, and motivating.

What sounds most exciting right now? *

Learning faster and doing better in school

Building something cool

Making money or exploring entrepreneurship

Getting organized and following through better

Exploring careers and future paths

A mix of foundations, projects, and coaching

What is one real problem in the student’s life that you wish was easier? *

What is one project or goal the student would love to finish in the next 30 days? *

If the student could build one app, tool, project, brand, or business, what would it do?

Preferred starting path

Safety, boundaries, and operating preferences

This is where we shape the guardrails and the household rules the coach should respect.

Any school, family, or household rules the coach should respect? *

Are there any topics, tools, or behaviors that should be off-limits?

What kind of accountability style is best?

Gentle nudges and encouragement

Direct accountability and clear push

Balanced, adaptive coaching

Would you want parent visibility or summaries?

No parent summaries needed

Light weekly summary

Weekly summary with strengths, weak spots, and next steps

Best contact email for next steps *

Consent and acknowledgment

This confirms who is participating, what the service is for, and what the coach should and should not be used for.

I confirm this questionnaire is being completed by a parent/guardian together with the child, unless the student is 18 or older.

I understand Acerox Youth AI Coaching is meant to build judgment, learning ability, and practical skills, not replace parental involvement or the student’s own thinking.

I understand AI systems can be useful but imperfect, and important claims or outputs should be verified before high-stakes use.

I understand the coach should support learning, planning, projects, and accountability, not cheating, impersonation, or unsafe behavior.

I agree to the Terms of Service and Privacy Policy.

Anything else we should know before recommending the student’s starting path?

Parent + child intake for Acerox Youth AI Coaching