Summer Group Inquiry
Child's Name
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date Picker Icon
Gender
Please Select
Female
Male
N/A
Child's Mother /Guardian 1
First Name
Last Name
Preferred contact number
-
Area Code
Phone Number
E-mail
Please choose weeks you would like to attend:
Cycle 1: July 10th-27th
Cycle 2: July 31st & Aug 17th
Which class are you interested in?
Tot readiness
Play and say (ST and OT)
Speech intensive
Social group
Does your child currently receive services ?
Yes
No
No, but I have concerns
Please share a little information about your child so groups can be formed according to your child’s needs. Please share any concerns you have, what your hoping your child will get out of this group, anything that would be helpful for us to know.
Once we have enough participants and can group accordingly you will be contacted for registration. Any questions please feel free to email us or call us !
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