Toddler Groups Registration Form

Toddler Groups Registration Form

151 Summit Ave, Summit, NJ 07901
Toddler groups (ages 2-4 years) will run from October 20-December 12th (see specific dates below). Groups will run weekly at the same time/date each week. You may sign your child up for one or multiple groups!
Registration will remain open until each group reaches full capacity. If you enroll your toddler after the group has started, you'll be responsible for a prorated fee based on the remaining dates in the 6-week session. Once you submit the registration form, our team will send you a payment link with the adjusted amount.
Group 1: Words & Wiggles, $660 per child for the full 6-week session
1. Tuesdays, 10:30 am - 12:30 pm (Dates: October 21, 28, November 4, 11, 18, 25)
2. Thursdays, 12:30 pm - 2:30 pm (Dates: October 23, 30, November 6, 13, 20, December 4)
3. Fridays, 11:00 am - 1:00 pm (Dates: October 24, 31, November 7, 14, 21, December 5)
Group 2: Munch & Mingle, $330 per child for the full 6-week session
1. Tuesdays, 12:30 pm - 1:30 pm (Dates: October 21, 28, November 4, 11, 18, 25)
2. Thursdays, 11:30 am - 12:30 pm (Dates: October 23, 30, November 6, 13, 20, December 4)
General Information
Child's Name:*
Date of Birth:*

MonthDayYear
Date
Parent/Guardian Name:*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Emergency Contact Information:*
Is your child potty trained?

YesNoIf not, please add more information:
Allergies/Medical Information:*
Photo/Video Consent:*

I give consent for my child to be photographed/ videotaped (advertising, publicity, or other business purposes including social media Facebook, Instagram, etc.)I do not give consent for my child to be photographed/ videotaped
How did you hear about these programs?*
Special Offer: If you sign up for a Words & Wiggles session and a Munch & Mingle session, you’ll receive $50 off your total payment.*

I want to sign up for both groupsI do not want to sign up for both groups

Group 1: Words & Wiggles
Join our fun and engaging toddler groups for ages 2-4 years old. Each group will be led by Speech-Language Pathologists and/or Occupational Therapists. Our 2 hour groups will support your child's communication, motor and social development through sensory, play and early communication activities. Come Wiggle and Grow with us!
Toddler groups (ages 2-4 years) will run from October 20-December 12th (see specific dates below). Groups will run weekly at the same time/date each week. You may sign your child up for one or multiple groups!
Words & Wiggles

Tuesdays, 10:30 am - 12:30 pm (Dates: October 21, 28, November 4, 11, 18, 25)Thursdays, 12:30 pm - 2:30 pm (Dates: October 23, 30, November 6, 13, 20, December 4)Fridays, 11:00 am - 1:00 pm (Dates: October 24, 31, November 7, 14, 21, December 5)
Please be advised that Words & Wiggles is a 6-week group program and cannot be submitted through insurance.

Cost: $660 per child for the full 6-week session
Group Size: Minimum of 4 children; limited spots available
Make-Up Policy: We offer 7 available group dates - if your child misses a week, you may attend the 7th week make-up session, or they may attend another session (if there is an open spot).

If you would like to sign up for multiple groups per week, you are welcome to do so. Once you submit your registration form, we will send you a payment link. Payment is due within 78 hours of receiving your registration. We accept credit card payments and checks.

Group 2: Munch & Mingle
Munch & Mingle is a 1-hour play-based feeding group for toddlers ages 2–4. Led by licensed Speech-Language Pathologists and Occupational Therapists.

The group focuses on picky eating, sensory-based food aversions, and mealtime challenges. Using evidence-based strategies derived from the SOS Approach to Feeding, children will explore new foods through fun, low-pressure, play-based activities designed to build positive mealtime experiences and increase comfort and exposure to new foods.
Toddler groups (ages 2-4 years) will run from October 20-December 12th (see specific dates below). Groups will run weekly at the same time/date each week. You may sign your child up for one or multiple groups!
Munch & Mingle

Tuesdays, 12:30 pm - 1:30 pm (Dates: October 21, 28, November 4, 11, 18, 25)Thursdays, 11:30 am - 12:30 pm (Dates: October 23, 30, November 6, 13, 20, December 4)
Please be advised that Munch & Mingle is a 6-week group program and cannot be submitted through insurance.

Cost: $330 per child for the full 6-week session
Group Size: Minimum of 4 children; limited spots available
Make-Up Policy: We offer 7 available group dates - if your child misses a week, you may attend the 7th week make-up session, or they may attend another session (if there is an open spot).

If you would like to sign up for multiple groups per week, you are welcome to do so. Once you submit your registration form, we will send you a payment link. Payment is due within 78 hours of receiving your registration. We accept credit card payments and checks.

Munch and Mingle Questionnaire

Skip this page if you have not signed up for this group
What are your child’s eating habits (e.g., grazer, sits at the table, open to trying new foods)
Any specific textures/flavors your child avoids?
What foods would you like them to explore?
Please list any additional information you’d like us to know about your child:

Payment Method
Please select the preferred method of payment:*

Credit Card/PayPal (Please note that a 2.9% transaction fee applies)Check (Make all checks payable to Creative Speech Solutions, LLC)
Once we receive your registration, we’ll send you the links to complete the forms for either online payment or check. Payment is due within 78 hours of receiving your registration.
Should be Empty:

Toddler Groups Registration Form

General Information

Group 1: Words & Wiggles

Words & Wiggles Questionnaire

Group 2: Munch & Mingle

Munch and Mingle Questionnaire

Payment Method