Three for Three Immersion   ~ 2019                                    
Three For Three Immersion
 3 days. 3 lessons/day

Nine - 25 Minute NeuroMovement® Lessons
One location
Two NeuroMovement® Practitioners
Follow-up consultation
Cost $720

3 families will be accepted for each Three for Three Immersion after completing the registration and submitting a deposit to hold the space.

A wait list will be created based on registration submission order.

Sign in to Google to save your progress. Learn more
JULY 31 - AUGUST 2, 2019
Name of Parent/Guardian (First and Last) *
Email *
Phone #: *
Participant Information
Name of Participant (first and last) *
Date of Birth of Participant: *
Brief general description of diagnosis:
Please tell us what  your child CAN do currently if applicable (i.e. crawling/reaching/counting)
What outcome/s would you hope for from the Three for Three Immersion?
What other therapies/modalities/devices does your child use or participate in currently
Please list any equipment/devices your child uses regularly
Thank you!
Kathy from MoveAbilities LLC  or Phoebe from Brilliant Movement LLC will contact you shortly after receiving your registration request outlining deposit payment information. Your deposit secures your place in our Three for Three Immersion.

When all slots are filled we will create a wait list for any spots that come available. Your deposit is non refundable unless another child from our waitlist can fill that slot.

Please contact Kathy or Phoebe  with any questions.

Phoebe MacRae ~ phoebe.macrae@gmail.com ~ 971-350-9636
Kathy Shean-Jones ~ kathy@moveabilities.com ~ 971-350-9633


THANK YOU

Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy