5-Week Onsite Therapy Programme Registration Form
Please fill in the details below to enroll your child in our holiday therapy programme.
Parent/Guardian Information
Full Name
First Name
Last Name
Your Phone Number (WhatsApp enabled)
Your valid E-mail
Confirmation Email
Residential Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child's Information
Full Name
First Name
Last Name
Age of Child
Gender
Male
Female
Other
Does your child have a professional diagnosis?
Yes
No
If yes, specify ( e.g., Austism, ADHD, Speech Delay, etc)
Preferred Location for Therapy
Preferred Location for Therapy
Greenzone Academy, 25 Oyemekun, Off College Road, Lagos
Acoms Global School. 13 Oduwole Street, Adigbe Abeokuta
Milestone Academy, Plot 611. 7th Avenue, Gwarimpa, Abuja
Preferred Time Slot (between 9am - 1pm)
9:00am - 10:00am
10:00am - 11:00am
11:00am - 12:00pm
12:00pm - 1:00pm
Select Therapy Package
Speech Therapy Ony - 1 hour daily (5times weekly) - ₦45,000
Speech + Behaviour Therapy 2 hours daily (5 times weekly) - ₦62,500
Speech + Behaviour + Occupational Therapy 3 hours daily (5 times weekly) – ₦75,500
How Did You Hear About This Programme?
I'm an existing parent with Greenzone Academy
WhatsApp
Website
Facbook
Referral
Other
Let us know anything specific we should be aware of
SUBMIT REGISTRATION
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