More Than Words Program - Register Your Interest
- You are invited to complete this form to register your interest in attending a free (no-commitment) Orientation session with a view to participating in an upcoming Hanen 'More Than Words' programme, run by Carolyn Webb, Speech and Language Therapist, CORU Reg. SL 015115, www.thespeechgrove.com.  This Orientation should help you to decide if you wish to participate in the full 3 month Hanen More Than Words program.

- Once you submit this form, you will be contacted before the next Orientation session with details on how to attend.

- Following the Orientation, you will be able to apply for a place on the full program if you wish.  There are usually two programs available but this may change at any time:

Tuesday Morning program fee: €800 payable in two instalments (receipts split over 8 session dates of €100)
Tuesday Evening program fee: €920 payable in two instalments (receipts split over 8 session dates of €115)

- Places for the full program are offered on a first come first served basis after the Orientation.  A maximum of 8 families are allowed to participate per full program.

Your information will be used to help plan for upcoming programs and to contact you.  Your information will not be shared with any 3rd party.  Your completion and submission of this form will constitute your consent to share your information with Carolyn Webb, Speech and Language Therapist for the reasons listed.
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Today's Date *
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Which Program time are you hoping to attend? (Pick ONE) The next Orientation will be in the Autumn. *
Please note which other times / days you would be able to attend. This will be taken into account when planning the full program.  Programs are usually run on Tuesdays or Wednesdays
Parents' / Guardians' full names *
Child's full name *
Child's date of birth *
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Address
Best telephone number *
Email address(es) *
How did you hear about us?
Reason for Interest in participating in the More Than Words programme - briefly describe your child's current communication challenges *
Briefly describe if your child has attended other services and results of assessments *
Please note any other information you feel is important
Thank you for taking the time to register your interest
Carolyn will be in touch closer to the time to let you know what dates are available to you.
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