Building Blocks School Prep Program Interest Form
Child's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Age
*
Parent/Guardian
*
First Name
Last Name
Please indicate which options you are interested in below. Our programs director will then be in touch with you via email or phone within 1-2 business days regarding your interest. Thank you for choosing TLC! We are looking forward to working with you
2 days a week/$823 a month
3 days a week/$1235 a month
5 days a week/ $1950 a month
Do you have a location preference?
Metairie Location
Elmwood Location
No preference/ First Available
Primary Phone Number
*
-
Area Code
Phone Number
Email
*
How you heard about Therapeutic Learning Center Programs?
*
Website
Flyer
Word of mouth
School
Facebook/Instagram
Please give our Programs Director 1-2 business days to contact you about your submission. Thank you!
Therapeutic Learning Center
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