Dyslexia School of Texas 2024-2025

Dyslexia School of Texas 2024-2025

Dyslexia Therapy Registration: Commitment is for ANY three days weekly M-Th, or maximize with all four!
Student Information
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
2024-2025 Grade*
Current School/Homeschool*
Please share any educational goals, concerns, or background you feel is helpful:
If applicable: previous interventions, evaluation information, IEP/504
Medication Allergies:
Food Allergies:
Other Allergies:
Physician Name*
Phone Number*
Please enter a valid phone number.
Preferred Hospital Name*
Family Information
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name*

First NameLast Name
Daytime Number*
Please enter a valid phone number.
Cell Phone*
Please enter a valid phone number.
Email*
example@example.com
Parent/Guardian Name

First NameLast Name
Daytime Number
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email
example@example.com
Emergency/Authorized Pick-Up*
Cell Phone*
Please enter a valid phone number.
Emergency/Authorized Pick-Up*
Cell Phone*
Please enter a valid phone number.
Select Preferred Dyslexia Therapy time:*

LEVEL 1: M, T, W, Th 4:00-4:55 PM - Come minimum of 3 days, or come all 4

My Products

Dyslexia Therapy Monthly Tuition Tuition charged monthly. 30 days cancellation required. Discount codes applied to first two months of enrollment.

$590.00

Annual Supply Fee

$150.00

Enter coupon

Total

$0.00

How did you hear about Dyslexia School of Texas
Registration and enrollment is not finalized or confirmed until student is assessed and matched for placement by Dyslexia School of Texas.*

Yes, I understand.
The commitment for the semester is the total tuition, divided into installments if I choose to use the payment plan; it is not a month-by-month enrollment.*

Yes, I understand.
Regulation Status: Dyslexia School of Texas is not a child care facility and is identified as a single-skills program exempt from Texas Child Care Licensing.*

Yes, I understand.
I grant the Dyslexia School of Texas the right to take photographs, videos, or digital recordings of my child(ren) for promotional purposes. I authorize the Dyslexia School of Texas its assigns, and transferees to copyright, use, and publish such photos in print and/or electronically. I agree that the Dyslexia School of Texas may use such photographs of my child(ren), without use of their name(s), and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content and I waive any right to financial or other remuneration arising or related to the use of the photographs.*

Yes, I consent.I consent to images that do not show my child(ren)'s face (ex. hands, arms, backside).No, I do not consent.

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Student Information