Information Request:
	Parent/Guardian Full Name  * required Address Child's Name  * required Date of Birth (dd/mm/yyyy)  * required E-mail Address
	Telephone Number
Area of Interest:
	Choose Your Programs Please list the programs you would like additional information on here. For summer programs please list the weeks you are interest in and full or half day. If you are interested in the Kindergarten Social Skills program, please check one of the following A.M
	P.M  Before & After Hours Care Before Hours After Hours Before & After Hours None Comments regarding your child ( communication skills, previous therapy, social goals & academic goals etc...)