Weekly Scheduling Availability
Summer
break*
School
year*
Bold fields required
Session
time
Child last
name:
Mon
Tue
Fri
Wed
Thu
8:00
Child first
name:
9:00
M        D          Y
Child date
of birth
10:00
Parent last
name:
11:00
Parent
first name:
2:00
3:00
email
Telephones - please provide at least one
4:00
Home
5:00
Cell
6:00
Comments
Work
Please note Creative Health Solutions strict privacy policy.
* Enter one form each for school
year and/or summer break