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Parent / Guardian Information

Relationship to Student
Preferred Method of Contact
Email
Phone Call
Text Message

Student Information

Student Date of Birth
Month
Day
Year
Current Grade Level
Place of Service Needed
Program of Interest
Academic Tutoring
Social, Emotional & Life Skills Programs
School Partnerships
Service Format
Not Sure

Student Learning Profile

Has your student received any evaluations or diagnoses?
No
Yes
If yes, please select all that apply
ADHD
Dyslexia
Autism Spectrum
Speech / Language Delay
Auditory Processing
Learning Differences
Anxiety / Emotional Regulation
Other
Does your student have any of the following?
IEP
504 Plan
Private Evaluation
School Evaluation
None of the above

Goals & Additional Information

Consent

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What Happens Next?

Thank you for taking the time to complete this form. We’re truly grateful for the opportunity to learn more about your child.

After submitting the form, the next step is to schedule a brief introductory call with a Team Kids team member. This call allows us to better understand your child’s needs, answer any questions you may have, and make sure we’re the right fit for your family.

You can easily schedule your call through the Team Kids Calendar link provided after completing this form.

If, after our conversation, you feel comfortable moving forward, we will send you an Enrollment Form by email. Once enrollment is completed, we will coordinate a start date based on availability and appropriate group placement.

We want this process to feel supportive, clear, and welcoming from the very beginning. Please know that we are here to guide you every step of the way.

We look forward to connecting with you soon.

Thank hyou so much for your help with this. 

Sincerely, 

Team Kids Therapy Center
Reception Desk

Phone: 305-438-5256
Email: info@teamkidstherapy.com
Website: www.teamkidstherapy.com

Academic • Personal Development • Life Skills | K–12
Every Child’s Journey Matters  

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