Parent's name * First Name Last Name Parent's email * Parent's phone number * (###) ### #### Home address * Child's first name * Child's age (Year and month) * Child's grade level * Preschool Junior Kindergarten Senior Kindergarten Grade 1 Grade 2 Appointment type * Individual Assessment $185 (Select 1 date below) Individual Lesson $185 (Select 1 date below) Package of 4 lessons $640 (Select 4 dates below) Package of 8 lessons $1120 (Select 8 dates below) Preferred Appointment date(s) and time(s) * Based on your response, you will receive an e-mail establishing a mutually convenient schedule. Do you wish to share additional information to help me better understand the needs of your child? Thank you. Your submission has been received. We will contact you with further details and e-mail an invoice for payment. Invoices must be paid 48 hours before the first appointment.