Clone of Ohio TES Summer Program Registration Form 2025 [Fairlawn]

TES Summer Program Registration Form

Social Skills Group, Feeding Therapy Group, Summer Reading, Executive Skills for Real Life
For more information or questions, please contact info.oh@tesidea.com

Address: 3428 W. Market Street, Fairlawn, OH 44333 Phone: (330) 668-4041

Address: 1930 Crown Park Ct., Suite 100, Columbus, OH 43235

Phone: (614) 695-3747

SELECT GROUP AGE AND TIMES
Categories:All

All

Fairlawn: Elementary Social Group (Ages 8-12 Years) 10:00 am-1:00 pm

Fairlawn: Elementary Social Group (Ages 13-17 Years) 10:00 am-1:00 pm

Columbus: Elementary Social Group (Ages 8-12 years) 10:00 am-1:00 pm

Columbus: Teen Social Group (Ages 13-17 years) 10:00 am-1:00 pm

Fairlawn: Feeding Therapy Group (Ages 4-7 years)

Fairlawn: Feeding Therapy Group (Ages 8-11 years)

Executive Functioning Skills for Real Life Consultation

Columbus: Summer Reading Groups (Ages 4-5)

Columbus: Summer Reading Groups (Ages 6-7)
prevnext( X )
Fairlawn: Elementary Social Group (Ages 8-12 Years) 10:00 am-1:00 pm

June 5
One Session

$95.00 Quantity



June 26
One Session

$95.00



July 17
One Session

$95.00



Fairlawn: Elementary Social Group (Ages 13-17 Years) 10:00 am-1:00 pm

June 12
One Session

$95.00 Quantity



July 10
One Session

$95.00



July 24
One Session

$95.00



Columbus: Elementary Social Group (Ages 8-12 years) 10:00 am-1:00 pm

June 5
One session

$95.00



June 26
One session

$95.00



July 17
One session

$95.00



Columbus: Teen Social Group (Ages 13-17 years) 10:00 am-1:00 pm

June 12
One session

$95.00



July 10
One session

$95.00



July 24
$95.00 Quantity



Fairlawn: Feeding Therapy Group (Ages 4-7 years)

June 1-4 / 10:30-11:45 am

$350.00



July 6-9 / 10:30-11:45 am

$350.00 Quantity



Fairlawn: Feeding Therapy Group (Ages 8-11 years)

June 1-4 / 12:15-1:30 pm

$350.00 Quantity



July 6-9 / 12:15-1:30 pm
$350.00 Quantity



Executive Functioning Skills for Real Life Consultation

Executive Functioning Coaching Intensive Consultation
6 week course focusing on practical skills to foster independence, focus and follow-through. Book a Free Consultation now with Jennifer Wolverton.

$ Free Quantity



Columbus: Summer Reading Groups (Ages 4-5)

Columbus Summer Reading Group
$40 per session Every Wednesday, June - July

$40.00 Quantity



Columbus: Summer Reading Groups (Ages 6-7)

Summer Reading Group (Ages 6-7)
$40 per session Every Wednesday, June - July

$40.00



Total

$0.00
Child's Information
Child's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
MaleFemaleOther
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Individuals Other than Parent/Guardian Authorization

Only these individuals have my authorization to care for my child in the event of an emergency and/or for drop-off and pick-up. Please advise these individuals they are authorized and will need to present identification to staff.
Contact's Name

First NameLast Name
Relationship
Contact's Name

First NameLast Name
Relationship
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement Waiver*
Medical Release and Authorization*
Assumption of Risk & Waiver of Liability Relating to Coronavirus/COVID-19*
Refund Policy*
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Parent/Guardian Signature

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Program Session of Interest:
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