2018 Fall Services
Registration is REQUIRED for ALL CLIENTS. Registration is DUE: Wednesday, July 25, 2018. If you register past this date, we cannot guarantee that you will get the exact schedule that you would like. Fall schedules will begin Monday, August 13*, UNLESS your child is on the balanced calendar system. Services continue through the entire school year.

Please complete this form in its entirety. The information you provide is vital to accurate scheduling. Please contact your clinic Office Manager if you have any questions. Thank you.


Email address *
Child's Name *
Your answer
Birthdate
MM
/
DD
/
YYYY
Guardian's Name:
Your answer
Phone Number *
Your answer
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