I would like to enroll my child in Creative Health Solutions Spring Break 2012 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
Morn
ing*
After
noon*
Days and times requested
Please note Creative Health Solutions strict privacy policy.
Monday April 2
Comments, suggestions:
Tuesday April 3
Wednesday April 4
Thursday April 5
Friday April 6
*Morning 10 - noon; Afternoon 2-4