Toddler Book Club Registration

Toddler Book Club Registration

Fill out the form carefully for registration. Group will take place on Fridays from 10:30-11:15 AM on October 30th, November 6th, 13th, and 20th, and December 4th. The fee for the 5-week session is $150. Our office will call to take your payment; unfortunately, we will not be able to do make-up weeks or pro-rated fees.
Caregiver's Name

First NameLast Name
Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Email
example@example.com
Mobile Number
Please enter a valid phone number. Speech therapist will call to confirm enrollment.Format: (000) 000-0000.

My child can:

Rows	Always	Sometimes	Never
Find named objects
Follow one step directions
Follow two step directions
Copy actions
Copy sounds
Use one word at a time
Use two words at a time
Use three or more words at a time
Answer yes or no (verbally or by head movement)
Answer wh- questions