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
What are your main concerns and goals for your child? Please answer below.
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
Other
Please give our Programs Director 1-2 business days to contact you about your submission. Thank you!
Therapeutic Learning Center
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