Flight! Journey 2 Excellence: Speech & Language Screening Sign-Up
Event Time: January 24th 10AM-1PM
Location: The Lakehouse at Grand Central Park
Contact us at (936) 703-3707 or morganwhite@flightjourney2excellence.com
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Parent/Guardian Name *
Email *
Phone *
Child's Name *
Child's D.O.B *
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/
DD
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Reason for screening  *
Time Slot *
10 AM
10:15 AM
10:30 AM
10:45 AM
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
1:00PM
Time
*I understand that this is a brief screening and not a full evaluation. Results will determine whether a formal assessment is recommended* *
Required
*I understand this is a screening only and does not diagnose or rule out a communication disorder*
 *
Required
*I consent to my child participating in this screening* *
Required
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