Social Skills Group Interest Form

Please indicate which group(s) you are interested in joining below. Our programs administrator will then be in touch with you via email or phone within 1-2 business days regarding your interest. Thank you for choosing TLC! We are looking forward to working with you 

Waiver

THERAPEUTIC LEARNING CENTER, LLC - PARENT

Permission Slip, Waiver of Liability, Indemnification, Medical Agreement and Grant of Rights

Permission Slip

I, the parent/legal guardian of this participant, hereby confirm that I am allowing my child to participate in the Therapeutic Learning Center, LLC’s (“TLC”) Social Skills Programs (“Program”).  I understand that the Program is completely voluntary and that no academic credit will be given for participation.  My signature below is an acknowledgement of voluntary consent to allow my child to participate in this Program. 

Waiver of Liability

My signature below indicates my understanding of the details of the Program. On behalf of my child, I voluntarily agree to accept any and all risks associated with their participation in the Program. On behalf of my child, I agree to forever indemnify, hold harmless, waive, and release TLC, its respective officers, members, employees, insurers, and representatives (“TLC Group”) thereof, from liability for any claim which I, any other parent or guardian, any sibling, the student, or any other person, firm or corporation may have or claim to have on my behalf or on behalf of my child, known or unknown, directly or indirectly, for any losses, damages, or injuries, including death, arising from, but not limited to, negligence, omissions, or fault, by or on behalf of TLC.

Indemnification

I agree to indemnify and hold harmless TLC Group from and against any and all claims, demands, expenses, losses and liability arising out of personal injuries or death to any person or the damage, loss or destruction of any property which may occur or in any way grow out of any act or omission by my child or any and all costs, expenses and/or attorney fees incurred as a result of any claims, demands, and/or causes of action, through, or under my child which may arise as a result of his or her participation in the Program.

Medical Agreement

If the participant has any special medical problems, allergies, dietary needs, handicap, special prescriptions, etc., please list (and use additional sheets if necessary) I have explained them in the registration form above.  

In case of an emergency, all attempts to reach me should be made to the  telephone number(s) stated above on the registration form. 

If any emergency medical procedures or treatments are required during the Program, I hereby consent to the staff of TLC’s Program, arranging for, or consenting to the procedures or treatment in his, her, or their discretion.  The only time a decision will be made in regard to serious illness or accident will be when extenuating circumstances prevent direct contact with parents/guardians regarding the matter.  My signature below also indicates that my child is in adequate physical condition to participate in the Program.

Grant of Rights

I, Parent/Legal Guardian, grant TLC the right and license to use my child’s liken, photographs and other attributes (collectively, “Approved Attributes”) to promote and advertise TLC’s services in the media including TV, radio, print advertising, point-of-sale materials, promotional materials, grass roots marketing efforts, public relations efforts and the Internet (to include but not be limited to web banners, blogs and social networking sites).

Declaration

By signing a copy of this agreement, I hereby acknowledge and agree to the above terms, including the PERMISSION SLIP, WAIVER OF LIABILITY, INDEMNIFICATION, MEDICAL AGREEMENT and GRANT OF RIGHTS.  I have reviewed and read this agreement.  The terms and conditions were explained to me in full, and I understand its terms and conditions.  I have been given ample opportunity to review this agreement with an attorney of my choosing.  My signature below is voluntary.  I further certify that I am of full legal capacity to execute this authorization. 

Severability

The Undersigned expressly agrees that the foregoing Release, Waiver and Indemnity Agreement is intended to be as broad and inclusive as is permitted by the laws of the State of Louisiana and that if any portion or portions thereof shall be held invalid, it is agreed that said portion shall be severed from this Agreement and the balance shall, notwithstanding, continue in full legal force and effect.

Afternoon Groups

Policies

Welcome to Therapeutic Learning Center’s Therapeutic afternoon groups! We are looking forward to a developmentally supportive, enriching and fun experience with your children. It is our philosophy at Therapeutic Learning Center that childhood should be a time full of fun, warmth, security, sharing, exploring, and discovery. Our goal is to provide a quality therapeutic group environment  that encourages social, emotional, physical, and intellectual growth and development of the child. Please see the following policies regarding payment and attendance to ensure your child’s success!

DROP OFF/PICK UP INSTRUCTIONS

Our afternoon groups occur at both our Metairie Road and Elmwood clinics. Our Metairie road clinic is located at 3329 Metairie Rd. and our Elmwood clinic is located at 524 Elmwood Park Blvd. Suite 120.

Elmwood Clinic:

For arrival/dismissal, please park in front of the building and walk your child into our front office waiting area. Our staff will greet you and transition your child into the classroom. For dismissal, please return to our front office waiting area, where the lead therapist will provide verbal feedback to you about your child’s participation in the group. 

Metairie Rd. Clinic:  

For arrival/dismissal, please park in front of the building and walk your child into our front office waiting area. Our staff will greet you and transition your child into the classroom. For dismissal, please return to our front office waiting area, where the lead therapist will provide verbal feedback to you about your child’s participation in the group.

FEEDBACK

Feedback will occur verbally at the end of each group. Upon request, feedback can also be provided on the brightwheel app if preferred.

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BEHAVIOR/SUPPORT POLICY

We understand that many children have behavioral challenges and benefit from a therapeutic environment; however, if we determine the behaviors are outside of our scope of practice, we may recommend outside services or providers that can help those children with aggressive behaviors. You may be asked to pick up your child for an aggressive incident that is dangerous for the other children or staff.  If your child has aggressive tendencies or demonstrates 3 or more aggressive behaviors toward other children or staff members while attending our program, we may recommend your child’s attendance to our program be placed on hold until other service providers are involved. Examples of these behaviors could include excessive biting, unprovoked aggression toward other children, or an excessive flight risk that would warrant one-on-one attention, etc. Refunds are not given in these instances. 

We understand that some children benefit from having one-on-one support to succeed. Suppose it is discovered that your child needs more support than our program can provide. In that case, we will recommend your child be placed in an alternative TLC program that will better meet their needs, discontinue enrollment, and/or suggest other services with outside providers to ensure the child's success.

 

DIVORCED/SEPARATED PARENTS AND CUSTODIAL ARRANGEMENTS 

Therapeutic Learning Center, LLC does not get involved in disputes between divorced, separated, or custodial parenting arrangements regarding financial responsibility for their child's medical expenses. By signing as guarantor below, you agree to be financially responsible for the care we provide to your child, regardless of whether a divorce decree, custodial, or other arrangement places that obligation on your former spouse or the child’s other parent. We will be happy to provide receipts for paid medical bills for you as requested. Feedback will be provided through the Brightwheel app and given to the caregiver who picks up the child. We are not able to provide feedback to multiple caregivers and ask that communication be shared among the caregivers.

ILLNESS

For the well-being of the children, please do not send your child when sick. NO CHILD WHO ARRIVES AT TLC, NOTICEABLY ILL, WITH A RASH, PINK EYE, EXCESSIVE COUGH, VOMITING, DIARRHEA, OR FEVER WILL BE ALLOWED TO ATTEND. 

A child can return to Connect Kids once they are not experiencing any of the following symptoms for at least 24 hours. 

Fever
Vomiting
Diarrhea
Contagious Rash
During the afternoon group, if your child experiences any of the following a parent or guardian will be notified immediately and asked to pick up your child. 

Present with a 100.4 fever or more
Experiences vomiting 
Experiences diarrhea 
If your child becomes sick at home and cannot attend the program, please email programs@tlcnola.com, send a message via the Brightwheel app, or call our office at 504-565-7300 as soon as possible. Refunds are not provided for illnesses.

EMERGENCIES

In the event of a personal emergency, please call the office (504-565-7300) to notify us of alternate arrangements for the pick-up of your child.

If there is a weather event that requires your child to be picked up, we will contact you and request that you pick up your child immediately or make arrangements for a designated person to pick up your child. No refunds will be given for weather event-related closures.

Please notify TLC through email at programs@tlcnola.com or phone 504-565-7300 if: 

Someone other than the usual person will be picking up your child. Your child will be released ONLY to persons you have designated on your information form under the pick-up list and will be asked to show an ID if we are not familiar with them.

TUITION POLICY

Beginning March 1st 2021, your child will be considered enrolled in our program on a continuous basis and you will be invoiced on a monthly rate based on your child's enrollment in his/her group one week prior to the month.

You are not required to re-register every month. Once enrolled, your child’s admission is considered continuous until you, the parent, emails TLC (programs@tlcnola.com) that your child will no longer be receiving our services. If you do not have a set time frame for your child, the leading SLP or OT will communicate with you when your child is ready to graduate from the group.It is very important that we receive at least one week’s notice when deciding to discontinue enrollment for your child. Written notice is required to programs@tlcnola.com, even if you verbally let the lead therapist know. No refunds will be provided if one week's notice is not provided in writing. You will owe one week's tuition past the date of dismissal if one week's notice is not provided.

 

Tuition is sent via invoicing to your email on file, from “Brightwheel” our electronic invoicing system. Tuition is due in full on the last day of each month. Tuition is to be paid electronically on the Brightwheel platform. Please make note that your invoice may go to the spam folder; thus, you will need to ensure that “support@mybrightwheel” is marked as a known address in your email account to prevent this from occurring. 

 

Invoices will be sent one week prior to the month your child will attend, unless there is availability to begin sooner. If your invoice is not paid by the last day of the month, your payment is considered late and you will be charged an additional fee of $25. If payment is not received by the 1st, a credit card will be REQUIRED to be maintained by TLC and your card will be charged with the late fee. If we do not receive a credit card from you, your child’s spot in the program may be placed on hold and he/she will be placed on the waitlist. 

 

Please utilize our “autopay” feature offered through brightwheel. This allows you to have a card on file and it will automatically charge you on the due date for the services. If you have any questions about this, please call our office or email programs@tlcnola.com. 

All Afternoon Groups (Lego group, Handwriting group, and Social Skills) - $150 per month

Holiday Closures

We will be closed for observance of the following holidays: New Years Day, Mardi Gras Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day.

WEATHER CLOSURES:

Refunds will not be issued in the event of unexpected TLC closure due to inclement weather. 

Attendance

In an effort to maximize the quality of our therapeutic groups, we are asking all participants to abide by the following attendance policy that has been in effect since July 1, 2021. As spots in our groups are reserved specifically for your child, we ask for consistent and regular group attendance.

Absences/Vacation:

Refunds or prorating will not be issued for unexpected absences, expected absences, early pick up, or late arrival. This includes but not limited to sick days, vacation days, or leaving early/arriving late due to personal commitments or prior appointments as we are continuing to hold the spot for your child.

In the event of a planned absence, please notify your group leader or email programs@tlcnola.com 24 hours ahead of the group start time to cancel so that they may structure the group accordingly. If a day-of emergency cancellation needs to occur, please email programs@tlcnola.com or call our office at 504-565-7300 to notify us of your child’s absence. In the event that the group leader is not notified within 4 hours of the group start time, or not at all, we will classify this absence as a no-show. In the event that your child no-shows for 2 groups within one month, we reserve the right to remove your child from the group and place them back on the waitlist. Furthermore, you remain financially responsible for your child’s place in the group regardless of missed days, as we are holding the spot for your child.

Consultation fee

In the case that your child requires consultation between TLC employees and school teachers or other professionals, we have a consultation fee ($20 per 15 minutes). This option, if needed, will be available to you after your child has attended at least 4 group sessions.

Trial policy

While our number one goal is to create a fun and supportive environment to facilitate success for all of our children, there are times in which our student ratio is not conducive to provide the level of support for those who require individual assistance to maintain safety and/or regulation throughout the group. Upon initial entry into the program, every participant will begin a trial duration of 2 groups in order for our therapist to evaluate if our program can provide the level of support needs required to set your child up for success. After the trial period, the therapist will provide you with feedback regarding the suitability of this program to meet your child’s current needs and goals. If it is determined that the program is not designed to support the level of support required for your child, we will provide recommendations for an alternate plan of action. Thank you for your understanding with this policy and please reach out with any questions or concerns. 

 Group Leaders

Renee Dussouy, - renee@tlcnola.com

Hayley Morgan,  hayleymorgan@tlcnola.com

Ray Noel, - ray@tlcnola.com

Sophie Sevin, - sophie@tlcnola.com

Amanda Uransky,COTA - amanda@tlcnola.com

We want to thank you for being a part of the TLC family and appreciate your cooperation with these policies. Our policies are in place with the sole purpose of providing quality services to all of our clients. Please reach out to the administration with any questions. Thank you!

 

Programs Contact info: programs@tlcnola.com , Phone number: 504-565-7300