Sensory Motor Social Group REGISTRATION FORM

Child Name(Required)
Parent Name(Required)
Address(Required)

COST

CURRENTLY ENROLLED Social Butterflies Club/Monarch Club Member Fee: $495.00

DATES: October 6, 13, 20, 27 November 3, 10, 17 December 1, 8, 15 FEE: $49.50 per 60 minute session *Fee INCLUDES Sensory Processing Assessment and interpretation as well as materials.

Non Member Fee- $640.00

DATES: October 6, 13, 20, 27 November 3, 10, 17 December 1, 8, 15 FEE: $55.00 per 60 minute session and one time $90.00 assessment fee *Fee INCLUDES Sensory Processing Assessment ($90.00)and interpretation as well as materials.

TIME OPTIONS

Time Preference(Required)
Please let us know your time preference. We will do our best to schedule your child during the time you select.

PAYMENT

Payment Preferences(Required)
Deposits paid will be applied to your child's tuition.
Price:
Consent(Required)
This field is for validation purposes and should be left unchanged.