Parent Full Name *

Email *

Phone *

Student Full Name *

Date of birth *

Student Shirt Size

all sizes are in youth unless you specify adult.

Any Allergies or other Medical information / triggers or concerns we should know?

Select An Option *

Neuro Diverse Program

Tuesdays & Thursdays 11:00 am - 11:45 am

$167

$129

Neuro Diverse Drop In

Drop in Rate

Tuesdays & Thursdays 11:00 am - 11:45 am

$35

$25

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