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Interest in PMC Programs
Please complete the information below so a member of our team may be in contact with you as soon as possible regarding your interest in PMC programming.
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Parent Name
*
Your answer
Telephone #
*
Your answer
Email Address
*
Your answer
Child's Name & Age
*
Your answer
What program are you interested in?
*
Level 1 Handwriting
Level 2 Handwriting
Feeding Clinic
Social Skills (3-5 year olds)
Social Skills (6-8 year olds)
Beautiful Beginnings
Therapy Intensive
Therapy at Private School or daycare (participating locations: Hagerstown Children's School Grace Academy, Broadfording Christina Academy, Heritage Academy)
Therapy Screening (at a medical practice, school, daycare, community center, or library)
ADOS-2 Testing
Diet & Nutrition Services
Other:
Required
Which PMC location are you interested in?
*
PMC - Hagerstown
PMC - Frederick
PMC Aquatics at Hagerstown
When are you interested in your child starting?
Immediately (Current Session)
Spring
Summer
Fall
Winter
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Additional Questions/Concerns/Comments:
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