Social Group Therapy Registration

LCTY Social Group Registration
WHEN: Programs run twice weekly June 5-July 28, 2023

WHERE: LCTY Delray Beach Clinic: 14565 Sims Rd | Delray Beach, FL
CHILD INFORMATION:
Child Name (1)

First NameLast Name
Birth Date

MonthDayYear
Child Name (2)

First NameLast Name
Birth Date

MonthDayYear
If you have more than two children to register, please include their first name(s), last name(s) and birthdate(s) at the bottom of the form in the 'Additional Information' box.
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number*
E-mail*
Enter the number of children being registered in each category below.
AGES 2-5
AGES 6-12
TEENAGERS
Sessions*
Categories:All

All

Weekly Sessions - MON & WED Morning

Weekly Sessions - TUE & THUR Afternoon

Monthly Sessions

Full Summer Sessions
prevnext( X )
Weekly Sessions - MON & WED Morning

Weekly Sessions - June 12 and 14$130.00
Monday and Wednesday Morning, 9am - 10am

Quantity

Weekly Sessions - June 19 and 21$130.00
Monday and Wednesday Morning, 9am - 10am

Quantity

Weekly Sessions - June 26 and 28$130.00
Monday and Wednesday Morning, 9am - 10am

Quantity

Weekly Sessions - July 3 and 5$130.00
Monday and Wednesday Morning, 9am - 10am

Quantity

Weekly Sessions - July 10 and 12$130.00
Monday and Wednesday Morning, 9am - 10am

Quantity

Weekly Sessions - July 17 and 19$130.00
Monday and Wednesday Morning 9am - 10am

Quantity

Weekly Sessions - July 24 and 26$130.00
Monday and Wednesday Morning 9am - 10am

Quantity

Weekly Sessions - TUE & THUR Afternoon

Weekly Sessions - June 13 and 15$130.00
Tuesday and Thursday Afternoon, 5pm - 6pm

Quantity

Weekly Sessions - June 20 and 22$130.00
Tuesday and Thursday Afternoon, 5pm - 6pm

Quantity

Weekly Sessions - June 27 and 29$130.00
Tuesday and Thursday Afternoon, 5pm - 6pm

Quantity

Weekly Sessions - July 4 and 6$130.00
Tuesday and Thursday Afternoon, 5pm - 6pm

Quantity

Weekly Sessions - July 11 and 13$130.00
Tuesday and Thursday Afternoon, 5pm - 6pm

Quantity

Weekly Sessions - July 18 and 20$130.00
Tuesday and Thursday Afternoon, 5pm - 6pm

Quantity

Weekly Sessions - July 25 and 27$130.00
Tuesday and Thursday Afternoon, 5pm - 6pm

Quantity

Monthly Sessions

Monthly Sessions - July | MON & WED $450.00

Quantity

Monthly Sessions - July | TUE & THUR$450.00

Quantity

Monthly Sessions - June | MON & WED$450.00

Quantity

Monthly Sessions - June | TUE & THUR$450.00

Quantity

Full Summer Sessions

Entire Sumer Sessions - MON & WED$850.00

Quantity

Entire Sumer Sessions - June & July | TUE & THUR$850.00

Quantity
Item subtotal:$0.00

Total $0.00
Please check the boxes to acknowledge and agree to the following:*

I acknowledge and accept that my child's photo may be taken during our social group sessions.
*

I acknowledge and accept that Little Champs Therapy and Yoga (LCTY) will try their best to reschedule my appointment if there is a cancellation within a reasonable time, and they will schedule me for the remainder part of the week only if they have the availability.
*

I will provide LCTY with the most notice as possible if I plan to cancel my appointment. I acknowledge and accept that LCTY's policy is at least to give at least 24 hours in advance for the latest cancellation time.
*

I acknowledge and accept that LCTY does not provide refunds, as per their established policies.
Additional information:
Should be Empty:

LCTY Social Group Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION: