Homeschool helps for Foreign Languages and Language Arts

Center For Neuro Development

PO Box 99369
Lakewood, Washington 98496-0369
Phone (253) 581-1588

PO Box 9346
Pueblo, Colorado 81008-9346

Phone (719) 423-6463

Keys for unlocking ADHD, LD, Autism and More!

E-Mail: maggie@centerforneurodevelopment.com maggie@homeschoolhelps.com
mdail@academynorthwest.net

     Web Site:       www.centerforneurodevelopment.com
                               www.homeschoolhelps.com
                               www.academynorthwest.org

Parent(s) Name:__________________________________________________________________________ Address________________________________________________________________________________ City/Zip________________________________________________________________________________

Telephone #____________________________________________________________________________

E-Mail address_________________________________________________________________________

SAT-Date ____________ITBS –Date _______________ (Schedule with Maggie before ordering materials from BJ Testing and Evaluation Service @ 1 800 845-5731 or Fax: 1 800 525-8398. E-mail: testing@bju.edu)

Grade of Test Student's Name Birth Date Grade

_________________________________________________________________________________________

Note: Please put an asterisk (*) by the name of any child who has never had an achievement test before. If your child has been diagnosed with Attention Deficit Disorder/Attention Deficit Hyperactive Disorder) please indicate with an "ADD" or “ADHD” by his/her name.

Payment:

Small Group Testing - minimum of 5 students:

Number of Students in a family ______ x $35.00=

Discount for three or more students in a family to be tested _____x $30.00=

Individual Sessions by appointment:

Number of Students to be tested ______ x $50.00 =

10% Discount for three or more children tested ________ x $45.00 =

Total (Enclosed) Please make checks Payable to: Ronnie Dail

__________

For your convenience we accept all major Credit Cards.

For online payment / registration: http://www.centerforneurodevelopment.com/product/014

Refunds for cancellations will be given up to 14 days prior to the first day of testing.

You may reschedule with At Least One - Week Advance Notice.