I would like to enroll my child in Creative Health Solutions Weekly Therapeutic Social
Pairs and/or Groups. I have selected all times that my child will be available.
 Bold fields
required
Starting
time
 Pairs 1 hour
session
 Groups 90-120
minute sessions
Mon
 Tue
 Fri
Wed
 Thu
Session type: must
check one or both
8:00
9:00
Child last
name:
10:00
Child first
name:
11:00
M        D          Y
Child date
of birth
2:00
Parent last
name:
3:00
Parent
first name:
4:00
5:00
email
6:00
Telephones - must have at least one
Comments
Home
Cell
Work
Creative will correlate clients preferences to find
common days and times; you will be notified and the
information will be posted on our website and in our
office.
Please note Creative Health Solutions strict privacy policy.