To learn more about our summer programs click here

Credit cards, check and cash are accepted. 

For other payment plans, please contact Lisa at l.dempseyslc@gmail.com

Summer Registration Form

Client Name *
Client Name
Parent Name *
Parent Name
Address *
Address
Phone
Phone
Please indicate what program you would like to sign your son/daughter up for.
A $100 non refundable deposit is required at the time of registration to hold your spot in a group. The $100 will be applied to your balance. If a group is not able to be offered you will be refunded your deposit in full. If a group is formed and you choose to no longer participate the deposit will not be refunded. By entering "$100" below you understand that you are committing to the nonrefundable deposit.
$
If you have any important information you need the office to know about your group, please indicate that here.
If you would like to participate in a 5 week social cognitive group, please let us know what days/time would be best for you.

Thanks for signing up. Someone from our office will confirm your spot within 48 hours of receiving your deposit.