More Than Words Program - Register Your Interest
- Please complete this form to register your interest in attending a free (no-commitment) Orientation session with a view to participating in an upcoming Hanen 'More Than Words' programme, run by Carolyn Webb, Speech and Language Therapist, CORU Reg. SL 015115, www.thespeechgrove.com.

- You may not be guaranteed a place on your preferred program: Places are offered on a first come first served basis. A maximum of 8 families are allowed to participate per program.

- Carolyn will be in touch with you closer to the time to let you know if you have a place on your preferred program or to offer you alternatives.

Your information will be used to help plan for upcoming programs and to contact you. Your information will not be shared with any 3rd party. Your completion and submission of this form will constitute your consent to share your information with Carolyn Webb, Speech and Language Therapist for the reasons above.
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Today's Date *
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Which Programme are you hoping to attend? (Pick ONE) *
Please note which other date(s) you would be able to attend if your preferred programme is not available. Please indicate your preference for a morning or evening program.
Parents' / Guardians' full names *
Child's full name *
Child's date of birth *
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Address
Best telephone number *
Email address(es) *
How did you hear about us?
Reason for Interest in participating in the More Than Words programme - briefly describe your child's current communication challenges *
Briefly describe if your child has attended other services and results of assessments *
Please note any other information you feel is important
Thank you for taking the time to register your interest
Carolyn will be in touch closer to the time to let you know what dates are available to you.
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