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Listen and Talk's Blended Classroom Preschool Inquiry Form

Listen and Talk teaches deaf and hard-of-hearing children how to listen and communicate using listening and spoken language. We believe that no child is limited by hearing loss. 

Our Blended Classroom Preschool Program offers half-day or full-day Preschool and full day Pre-K options to deaf or hard of hearing students enrolled in our program in Kirkland or Seattle, WA. 

We also offer a Hearing Peers Preschool Program where peers with typical hearing from nearby towns can participate in our preschool program based in Kirkland, WA and learn side-by-side with children who have hearing loss. 

To inquire about enrollment, program options or services, please fill out the form below.

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Parent/Guardian First Name:
*
Parent/Guardian Last Name:
*
Email Address *
Phone Number *
Preferred Contact Info? (Phone and/or Email)
*
Child's Name:
*
Child's Birthdate:
*
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Does your child have hearing loss? *
Required
Does your child use any hearing assistive technology?
Please indicate what kind of hearing technologies your child may use (cochlear implant, hearing aid, BAHA, other assistive technologies) to help us respond to your inquiries.
If you are interested in our Hearing Peers Preschool Program, does your child have typical hearing?
Typical hearing means a child that has no hearing loss of any sort and can hear without aid/support.
How did you hear about us?
*
What would you like to learn more about? 
*
I'd like to learn more about the following: Blended Classroom Preschool enrollment, Hearing Peers Preschool Program, Program options, curriculum, auditory strategies, etc. 
By submitting this form, you understand that you agree to be contacted by Listen and Talk and be subscribed to our email list updates.
Parent Signature
*
Sign here with your full name.
Parent Signature Date
*
Please submit today's date.
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