"Three for Three" NeuroMovement® Lesson Intensive Registration 2019
Three For Three
3 days. 3 lessons/day

Nine - 25 Minute NeuroMovement® Lessons
One location
Two NeuroMovement® Practitioners
Follow-up consultation
Cost $720

6 families will be accepted for each "Three for Three" intensive after completing the registration and submitting a deposit to hold the space.

A wait list will be created based on registration submission order.

Name of Parent/Guardian (First and Last) *
Your answer
Email *
Your answer
Phone #: *
Your answer
Name of Participant (first and last) *
Your answer
Date of Birth of Participant: *
Your answer
Choose which Three for Three intensives you are able to attend
You may sign up for one, or all!
You can also come back to this form and sign up at a later time.
January 23 - 25, 2019 - deposit due now
May 1 - 3, 2019- deposit due on or before April 1
July 24 -26, 2019 - deposit due or before June 1
October 23 - 26, 2019 - deposit due or before Sept 1
Participant Information
Please fill this data in for your first Three for Three intensive.
After that, you may skip to the bottom and click submit.
Have you submitted a form in the past?
Brief general description of diagnosis:
Your answer
Please tell us what your child CAN do currently if applicable (i.e. crawling/reaching/counting)
Your answer
What outcome/s would you hope for from the "Three for Three" Intensive?
Your answer
What other therapies/modalities/devices does your child use or participate in currently
Please list any equipment/devices your child uses regularly
Your answer
Thank you!
Kathy from MoveAbilities LLC or Phoebe from Brilliant Movement LLC will contact you shortly after receiving your registration request outlining deposit payment information. Your deposit secures your place in our Three for Three offering.

When all slots are filled we will create a wait list for any spots that come available. Your deposit is non refundable unless another child from our waitlist can fill that slot.

Please contact Kathy or Phoebe with any questions.

Phoebe MacRae ~ phoebe.macrae@gmail.com ~ 971-350-9636
Kathy Shean-Jones ~ kathy@moveabilities.com ~ 971-350-9633


THANK YOU

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