Small Groups Application 2026

  • Exceptional Me small groups program

    Small Groups Application

  • See what we are all about !!!

    Visit us on

    - OT4Kids.com

    - Instagram @ot4kids.inc

    -Tik Tok @ot4kids_inc

    -FB Exceptional Me

    -FB OT4Kids,inc.

    -Text 336-236-6546 to set up a Tour or have questions about our programs

    SIGN ME UP: Please text "DEPOSIT" to 336-236-6546 for a direct deposit link or call 336-236-6546 select option #6 to speak to our staff.

    $100  deposit is applied to the total cost of $495 leaving a balance of $395 to be paid infull before each 8 week session unless other arrangements have been made with our Administrator.

    -We are an ESAgrant provider

     

     

  • Allergies * . Allergies to farm animals ? *

  • Likes and dis-likes ? . Favorite snacks / food

  • DOB . My child prefers to be called .

  • If there are challenges in the areas of emotional awareness, self regulation, social skills, health and wellness, or others challenges that may effect groups participation please let us know in the space provided.?

  • Are you registering for the 4 -5 yr old "Academic Readiness Group? . If yes, what is your child's current age?

  • Format: (000) 000-0000.

  • Payment Agreement 

    -The Exceptional Me Program runs in 8-week increments throughout the academic school year. Groups meet 1 time a week for 2 hours per meeting. The cost listed above is per eight week session (exception: a seasonal or event discount is in effect and has been applied). Price is adjusted accordingly in the check out options.

    -If joining after an eight week session has begun, a prorate will be calculated for the reminder of the session resuming the stated 8 week price for the following session.

    -Each child:One free T-shirt is provided and should be worn each week while attenting groups. 

    -Payment is in full beore session begins unless a payment arrangements have been made with our Administrator.

    -$100 non-refundable deposit is due with application. Payment link is provided upon request. Please text "DEPOSIT" to (336-236-6546). This deposit holds your child's place and will be applied to the remaining balance for the initial session. Additional sessions do not require a deposit. 

    -Due to the importance of attendance when enaged in small groups once a group session is paid for in full and has begun, any missed meetings by the child are forfited to encourage weekly attnedance that benefits all children attending. 


    -If the Instructor must cancel a class due to unforeseen circumstances or illness, the class will be made up by extending the session 1 week.

  • Responsible Party . Date

  • Personal Injury Waiver Form

    This Personal Injury Waiver (the "Waiver") is made by the undersigned for the purpose of utilizing the facilities and premises managed by OT4KidsInc., (the "Company"), with the location at 440 Central Ave, NC 27292. and in the acknowledgment that in the utilization of the premises and facilities of the Company, occupies risk of personal injury that may arise or happen at any time.

    In consideration of the Company allowing the undersigned to make use of the venue and its facilities and equipment for the relevant purpose by which the Company allows, the undersigned agrees to assume the foreseeable and unforeseeable risk of personal injuries related to the activity, and agrees to release, discharge, and hold harmless the Company, its owner(s) and employees free from any and all liabilities, claims, cause of action, damages, or losses, which may be incurred by the undersigned in using said premises and its equipment and/or facilities, and which may arise from any reason whatsoever, specifically including, but not limited to, any negligence on the part of the owners, its employees, or losses arising from theft or for any other reason whatsoever.

    This Waiver shall be binding upon the parties, their respective heirs, representatives, successors, and assigns.

    In case any part of this Waiver be construed as improper or invalid, such invalidity will affect only that part of this Waiver and the rest shall remain valid and enforceable.

    Any alteration, modification, or amendment to this Waiver shall not be considered as valid unless otherwise written and signed by the undersigned herein.

  • Name of responsible party . Date .

  • I hereby grant The Exceptional Me and OT4 Kids inc. staff the irrevocable right and permission to use photographs and/or video recordings of me and/ or my child on OT4 Kids and other websites, publications, social media platforms, in promotional flyers, educational materials, derivative works, or for any other similar purpose without compensation to me. This request is in efforts to offer this small groups opportunity to others who can benefit from the unique setting the Exceptional Me Program offers.

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