I would like to enroll my child in Creative Health Solutions Therapeutic Social Groups
M        D          Y
Child last
name:
 Child first
name:
 Date of
birth
Parent
first name.
Parent last
name:
email
Bold fields
required
Secondary
telephone
Primary
telephone
Days and
times
available
11:00
12:30
8:00
9:30
 9:00
10:30
 9:30
11:00
 10:00
11:30
 10:30
12:00
 11:30
1:00
 12:30
2:00
 1:00
2:30
 1:30
3:00
 2:00
3:30
 2:30
4:00
 3:30
5:00
 4:00
5:30
 4:30
6:00
 5:00
6:30
 5:30
7:00
 6:00
7:30
8:30
10:00
 12:00
1:30
3:00
4:30
Mon
Tue
Wed
Thu
Fri
Please note Creative Health Solutions strict privacy policy.
Comments, suggestions:
Creative will correlate clients preferences to find common days and times; you will be notified and the information
will be posted on the web and in the office.