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Class Registration

Please fill out the form below to register for Sensory Bounce® Class

RATES

Sensory Bounce® Classes are $100 per class.

PLEASE NOTE:

By registering for Sensory Bounce® classes you are agreeing to the following:

Classes with fewer than 4 participants may be canceled or combined with other like classes

We reserve the right to dismiss any child who is disruptive to the class

To maintain consistency for all participants, initial registration is an 8-week commitment, after which participants may opt out on or before the 25th day of the month

Sensory Bounce® requires class participants to make a concerted effort to attend ALL classes in order to maintain their spot in the class

Participants will be responsible for the cost of the class if Sensory Bounce® is not notified of a cancellation 24 hours before the class

Sensory Bounce® will direct bill for participants who have received approval to attend Sensory Bounce® as a community class

Credit cards for self-paying members will be charged after the final session of every month for the following month

There are no refunds once registration form is submitted unless the CLASS INSTRUCTOR feels the child is not a good fit for the class.

Sensory Bounce® offers a limited number of scholarships

REGISTER HERE for Classes

Choose a Program *

Parent Full Name *

First Child’s Full Name *

Child Birth Day *

Current Grade *

Is your child verbal? *

Can your child follow basic directions? *

Is your child aggressive? *

Has your child ever been without a parent?*

Second Child’s Full Name *

Child Birth Day *

Current Grade *

Diagnosis *

Is your child verbal? *

Can your child follow basic directions? *

Is your child aggressive? *

Has your child ever been without a parent?*

Contact Number *

Email Address *

Address

State/Prov *

City *

Zip Code *

Type Of Credit *

Visa Card

Master Card

American Express

Name On Card *

Card Number *

Card Exp. Date *

Card's Security Code *

By submitting this information you are acknowledging that you understand the terms of the program and are authorizing your card to be charged for the full amount of the program listed above for the entire time you are enrolled in our program

Please call the office if you have self direction or are funded by an organization.

Please check to confirm *

I agree to the terms and authorize Sensory Bounce® Therapy to charge my card.

How did you hear about us ? *

I will be joining the parent support group *

I will be joining other parents in the group meeting room

Yes, I would love to

No, thank you

Referral Details *

Please provide any information you feel we should know about your child such as specific issues/fears.

Are you currently enrolled in self direction or receive funding from any other public or private organization.

Yes

Class Registration

Please fill out the form below to register for Sensory Bounce® Class

RATES

By registering for Sensory Bounce® classes you are agreeing to the following:

REGISTER HERE for Classes

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