Please enable JavaScript in your browser to complete this form.Registrant Name *FirstLastResponsible Party Name *FirstLastAddress Line 1 *Address Line 2City *State *Zip Code *Email *Home Phone Number *Cell Phone Number *Session ScheduleMondaySession Start Time-8:00 am8:30 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pmType of SessionPlease select the type of sessionSpeech Language Pathology Services - 30 minutesSpeech Language Pathology Services - 60 minutesMusic Lessons - 30 minutesMusic Lessons - 60 minutesSchedule of SessionsTuesdaySession Start Time-8:00 am8:30 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pmType of SessionPlease select the type of sessionSpeech Language Pathology Services - 30 minutesSpeech Language Pathology Services - 60 minutesMusic Lessons - 30 minutesMusic Lessons - 60 minutesSchedule of SessionsWednesdaySession Start Time-8:00 am8:30 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pmType of SessionPlease select the type of sessionSpeech Language Pathology Services - 30 minutesSpeech Language Pathology Services - 60 minutesMusic Lessons - 30 minutesMusic Lessons - 60 minutesSchedule of SessionsThursdaySession Start Time-8:00 am8:30 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pmType of SessionPlease select the type of sessionSpeech Language Pathology ServicesSpeech Language Pathology Services - 60 minutesMusic Lessons - 30 minutesMusic Lessons - 60 minutesSchedule of SessionsFridaySession Start Time-8:00 am8:30 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pmType of SessionPlease select the type of sessionSpeech Language Pathology Services - 30 minutesSpeech Language Pathology Services - 60 minutesMusic Lessons - 30 minutesMusic Lessons - 60 minutesSchedule of SessionsSaturdaySession Start Time-8:00 am8:30 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pmType of SessionPlease select the type of sessionSpeech Language Pathology Services - 30 minutesSpeech Language Pathology Services - 60 minutesMusic Lessons - 30 minutesMusic Lessons - 60 minutesSchedule of SessionsSundaySession Start Time-8:00 am8:30 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pmType of SessionPlease select the type of sessionSpeech Language Pathology Services - 30 minutesSpeech Language Pathology Services - 60 minutesMusic Lessons - 30 minutesMusic Lessons - 60 minutesCognitive CareDementiaExecutive FunctionMCIAphasiaTBIVisual MemoryLanguage & LearningAutism Spectrum DisordersExpressive LanguageLiteracyReceptive LanguageWritten LanguageTutoringAural RehabilitationAuditory DiscriminationCAPDHearing & CognitionAudiology ResourcesAuditory ComprehensionAuditory MemorySpeech TherapyApraxiaArticulationDyslexiaEarly InterventionFluencyVoiceCommentREGISTER AND MAKE PAYMENT
