Skip To Main Content

Registration Form

Required

Child's Name:required
First Name
Last Name
Must contain a date in M/D/YYYY format
Parents' / Caregivers' Name(s):required
First Name
Last Name
Preferred Contact Method:required
Do you have specific concerns about your toddler's development at this time?required
Does your toddler currently participate in any special services (e.g., physical therapy, occupational therapy, speech therapy, Babies Can't Wait)?required
Does your toddler have any siblings?required
Please check all that apply to your toddler:requiredPlease select up to 16 choices
Please select up to 16 choices
Please select one session to register for:required
$360.80

Payment Information

Provide an email address for the receipt.

Please complete captcha below to proceed to payment selection.

Please select a payment typerequired
Billing Addressrequired
Cardholder Namerequired
Expirationrequired