Social Skills / Sensory
SOCIAL AND HANDWRTING GROUPSEnrollment and Reservation Form Below SOCIAL SKILLS GROUPS
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MARLTON
544 Lippincott Drive, Marlton, NJ 08053
PLAYTIME PALS (3-5 years)
10 weeks, 1 hour each week
Mondays 4:15 pm to 5:15 pm
KIDS CONNECT (6-9 years)
10 weeks, 1 hour each week
Mondays 5:30 pm to 6:30 pm
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HANDWRITING GROUPS
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ENROLLMENT: SENSATIONAL
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Child’s name: |
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Diagnosis: |
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Parent Name: |
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Precautions |
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WHAT ISSUES / SKILLS DO YOU HOPE TO IMPROVE BY SIGNING YOUR CHILD UP? (BE AS SPECIFIC AS POSSIBLE) |
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MARLTON : Play Time Pals and Kids Connect, and Star Writers Group Sessions |
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SELECT |
Play Time Pals Kids Connect Star Writers |
DAY/ TIME |
FIRST SESSION |
LAST SESSION |
RATE |
DEPOSIT (non- refundable) |
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Play Pals Kids Connect Star Writers |
SUMMER 2010 |
PP: Monday 4:15 KC: Mondays 5:30 SW: Thursdays 4:30 |
Play Time Pals: 7-5-2010 Kids Connect: 7-5-2010 Star Writers: 7-8-2010 |
Play Time Pals: 9-13-10 Kids Connect: 9-13-10 Star Writers: 9-9-2010 |
$499 ( 10 wks / 1 hr wk) |
$ 100 By: 5-21-10 |
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Play Pals Kids Connect Star Writers |
FALL 2010 |
PP: Monday 4:15 KC: Mondays 5:30 SW: Thursdays 4:30 |
Play Time Pals: 9-27-2010 Kids Connect: 9-27-2010 Star Writers: 9-30-2010 |
Play Time Pals: 12-29-10 Kids Connect: 12-29-10 Star Writers: 12-2-10 |
$499 ( 10 wks / 1 hr wk) |
$100 By: 8-27-10 |
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POLICIES: · ALL FEES & DEPOSITS ARE NON-REFUNDABLE · WE DO NOT PRORATE FOR MISSED SESSIONS · PAYMENTS NOT APPLICABLE TO OTHER SERVICES · BALANCE OF $399 DUE ON FIRST DAY OF GROUPS · PARENTS MUST COMPLETE ENROLLMENT FORM FOR EACH GROUP SESSION, REGARDLESS OF PREVIOUS ATTENDANCE. **Please note if school district is paying, parent must pay in full for group until school district renders the payment ( this process could take up to 90 – 120 days), than the parent will be directly reimbursed through Sensational Kids QUESTIONS / KNOW MORE ABOUT US: ( (856) 810 – 5777 / www.iamasensationalkid.com |
PAYMENT: · Payment options: Phone or in person credit card payment: Visa, Master Card / Checks / Cash · Checks payable to Sensational Kids · Mail this form to: Sensational Kids, |
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Does your child have a one on one assistant in school _____ Yes/ ___ NO Please be specific |
I ___ AGREE / ___ DO NOT AGREE to my child being photographed during scheduled Sensational Kids activities (Such photography may be used by Sensational Kids for publicity, website and educational purposes in the future.) |
Please be aware that parents will be responsible for providing a one on one assistant within the group if the therapist determines that your child will require such a level of assistance in order to continue to benefit from the group experience.
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