If the number of participants who would like to attend is different than the number you paid for in your registration, please email email@example.com.
Please provide the full name of each participant, their preferred pronouns, and their relationship to the primary participant. Remember, if the primary client is a student, a least one parent or adult support figure MUST attend the sessions as well.
General Intake Information
ADD/ADHD, Dyslexia, Learning Differences, Gifted and Talented, Processing Disorders, Premature Birth, Adopted, Mental Health Diagnosis
Please let us know how you heard of us.
Additional Questions for Students and Families
Please fill out this section if the primary participant is a student.
I understand that a 100% refund is available up until two weeks before the first day of class. A 50% refund is available from two weeks prior to the first day of class through the second class. No refunds are available after the second week of class.
I understand that if for any reason, the group environment isn’t suitable for myself or my student, I may apply the cost of the group course towards private sessions at a pro-rated amount.