Handwriting Club Registration
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
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Email *
Child's Full Name *
Child's Date of Birth *
Which session will your child attend? *
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? *
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.
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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? *
If so, please describe:
Hand dominance *
Is there anything else you would like us to know about your child?
Dietary restrictions *
Does your child have any allergies? *
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. *
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. *
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:
What is your preferred payment method? *
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. *
A copy of your responses will be emailed to the address you provided.
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