Child's Name Parent's Name Parent's Email Address Child's Grade Level Kindergarten 1st 2nd 3rd 4th 5th Days of the Week (First Choice) Monday Tuesday Wednesday Thursday Time of Day (First Choice) 4:00 p.m. 4:30 p.m. 5:00 p.m. 5:30 p.m. Days of the Week (Second Choice) Monday Tuesday Wednesday Thursday Time of Day (Second Choice) 4:00 p.m. 4:30 p.m. 5:00 p.m. 5:30 p.m. We will do our best to accommodate your first or second appointment slot preferences. Please share any other details regarding your weekly preference (for example: You can do any time slot on any day, You are free all time slots on Wednesdays, etc.). CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Leave this field blank
