Handwriting Club Registration

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Handwriting Club is an outdoor, multi-sensory group designed to build writing + fine motor skills using the Handwriting Without Tears® method. Designed for TK to rising 3rd graders / 5 to 8 years old.
To learn more, read the FAQs at https://www.hillertherapy.com/handwritingclub.

Contact Leah at (323) 641-3662 or Leah@HillerTherapy.com

Email *

Child's Full Name *

Child's Date of Birth *

YYYY

Which session will your child attend? *

SUMMER 1 - Fridays, 3:30-4:30pm, 7/8-8/12 (6 Fridays)

SUMMER 2 - Fridays, 4:30pm-5:30pm, 7/8-8/12 (6 Fridays)

SUMMER 3 (INTENSIVE) - Monday-Friday, 10:30pm-Noon, 7/11-7/15 (5 days)

SUMMER 4 (INTENSIVE) - Monday-Friday, 10:30pm-Noon, 7/25-7/29 (5 days)

SUMMER 5 (INTENSIVE) - Monday-Friday, 10:30pm-Noon, 8/8-8/12 (5 days)

I'm interested in the group for FALL 2022. Contact me when registration opens.

Required

Parent/Caregiver #1 Name *

Parent/Caregiver #1 Phone *

Parent/Caregiver #1 Email *

Parent/Caregiver #2 Name

Parent/Caregiver #2 Phone

Parent/Caregiver #2 Email

Is a person authorized to pick up your child other than the parent(s) listed above? *

Yes

If so, please write the authorized person's full name and phone number.

I understand that the authorized person must present a valid ID that matches the name I provide.

Yes

Clear selection

Child's School *

Child's Grade this Fall *

What special interests or hobbies does your child have? *

Please tell me about any handwriting challenges reported or noticed: *

What do you hope to gain from Handwriting Club? *

What handwriting curriculum has been used to instruct your child?

Does your child receive any other specialized support? *

Yes

If so, please describe:

Hand dominance *

Left

Right

Undecided

Is there anything else you would like us to know about your child?

Dietary restrictions *

None

Vegetarian

Vegan

Kosher

Gluten-free

Other:

Does your child have any allergies? *

Yes

If so, please describe:

I understand that Hiller Therapy is nut-free. We follow nut-free guidelines for the safety and health of everyone. Please do to bring nuts. *

Yes

We have extensive COVID-19 precautions in place. Once your registration is completed, you will receive the COVID Consent that outlines our policies in detail. I understand that this must be signed and followed for your child's participation in Handwriting Club. *

Yes

Payment Details

Handwriting Club costs $510 for each 6-session group. That comes out to $85 per session.
- Because the group experience is an important part, we cannot offer a daily rate.
- While we are not in-network for any insurance providers, we can provide a superbill for insurance reimbursement if your child meets certain criteria.

Cancellation Policy:

You must notify the Leah via email of any cancellations at Leah@HillerTherapy.com.

Cancellations less that 10 days prior to the first day of the session your child is attending will result in a full refund, less a non-refundable deposit of $100.

Credits will be issued for any programming that begins within 10 days of cancellation.

No refunds or pro-rated shall be permitted if a camper leaves before the end of the session. One make-up day is offered per session. Make-ups take place during a subsequent session. We do not offer partial payment for days missed.

What is your preferred payment method? *

Credit Card

Check to Leah Hiller Therapy

I understand that registration is not complete until payment is made in full. I understand that $100 of this fee is not refundable. I have reviewed the cancellation policy. *

Yes

A copy of your responses will be emailed to the address you provided.

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