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Class Signup Form
Individual Handwriting Improvement Class (School-Aged)
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* Indicates required question
Caregiver Name:
家長資料
*
Your answer
Phone Number
連絡電話
*
Your answer
Email Address
電子信箱
*
Your answer
Home Address
地址
Your answer
Child's Name
孩童姓名
Your answer
Child's Date of Birth:
孩童生日
*
MM
/
DD
/
YYYY
How many classes you would like to sign up?
請問您要報名幾堂課程?
*Minimal 4 classes registration required. 最少要報名4堂課
*
Your answer
Please let us know your availability for attending the class? (We will contact you shortly to help you schedule within your availability)
請告知預計參與課程的時間? (報名後會有專人聯繫您預約上課時間)
*
9:00am-12:00pm
1:00pm-5:00pm
5:30pm-6:30pm
Monday
Tuesday
Thursday
Friday
Saturday
9:00am-12:00pm
1:00pm-5:00pm
5:30pm-6:30pm
Monday
Tuesday
Thursday
Friday
Saturday
Is your child receiving following services?
您的小孩目前有接受(過)任何治療/服務嗎?
Early Intervention services (Usually these services are funded by local regional center and provided to children in home and for children ages, birth to three)
School-Based Occupational Therapy
Occupational Therapy other than School-Based
Physical Therapy
Speech Therapy
ABA
No service is receiving at this time
Other:
How did you hear about us?
您如何知道我們的?
(optional but we'd love to know how you got here!)
Your answer
THANK YOU VERY MUCH YOUR INTEREST IN OUR CLASSES!
Our pediatric intake team will be contacting you soon to answer any and all questions you might have and help you schedule within your availability.
非常感謝您對我們課程的關注！我們的團隊將會盡快與您聯繫，回答您可能有的所有問題，並幫助您根據您的時間安排上課時間。
*Minimal 4 classes registration required.
The fee will be due before the first session.
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