Registration individual course for children

name of the parents

first name of the child

gender

girl

boy

family name of the child

date of birth

grade (kindergarten, school)

mother tongue

e-mail parents

phone number parents

adress (street, postcode, domicile)

Please note what your child needs. Please let me know when you have already made some therapy or test or something. Thanks.

Agreement of mother and father

yes

More information

How have you heard about this course?

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Hinweis: Bitte die mit * gekennzeichneten Felder ausfüllen.