Summer Speech Academy Name of Parent/Caregiver * First Name Last Name Email * Phone (###) ### #### Grade of Child I have concerns with my child's: My child has IEP goals in the following areas: How many weeks of summer speech therapy are you registering for? Undecided; but I will commit to the 4 week minimum 4 weeks 5 weeks 6 weeks 7 weeks 8 weeks What therapy option are you interested in? * Two, 15 minute sessions per week at $80/week Two, 30 minute sessions per week at $155/week I would like to discuss other options I am interested in receiving $50 off of initiation of services once Summer Speech Academy ends! * Yes No Message Thank you for registering for our Summer Speech Academy! We will reach out within 48 hours to schedule a consultation and begin planning your child’s speech services for the summer. REGISTRATION
