Booking Enquiry Form
This form is for parents seeking one to one structured literacy therapy sessions for their child/ren. 
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Parent's Full Name
Email
Phone Number
Location (Suburb & State)
Child's Full Name
Child's Age
Child's School Grade Level
Child's School
Are you available during school hour sessions?
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Are you looking for online lessons/ face to face or either *
Does your child have a diagnosis of any kind? Please note in brief.
If no diagnosis, are you suspecting a learning or neurological difference?
How do you prefer that we contact you? *
Is there anything else you would like us to know before we contact you?
Submit
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This form was created inside of All Kids Can. Report Abuse