Parent's Name

Email *

Phone *

Child's Name *

Child's Date of Birth *

This speech camp is 8 weeks long and takes place on Thursdays at 9:00am-10:00am starting on June 5.

We won't meet the week of July 4th.

Tell Us A Bit About Your Child *

Does your child currently receive speech therapy? *

Y

N

Has your child been diagnosed with a speech sound disorder? *

Y

N

What goals do you have for your child's speech? *

What else would you like me to know about your child's speech? *

Total cost per camp is $400.

$200 deposit required to hold your child's spot.

Your card will be charged the remainder of the balance two weeks before camp date.

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