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Child's Name

Birthday

Describe your child's specific area(s) of need ( trauma, anxiety, anger, attention span etc..)

Parent's Name

Email

Phone

5 week session cost is $50

Child's age class time

3:30 P.M. Ages 5 thru 8

4:15 P.M. Ages 9 thru 12

5:00 P.M. Ages 13 thru 17

Thanks for registering!

Tel : 708 654-1361

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