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  • Lighthouse Therapy and Education Centre: Registration Form

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    Meliza
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    This document is a registration form and guide to policies for Lighthouse Therapy and Education Centre. It requests information such as the child's name, date of birth, medical information, and emergency contacts. It also provides the centre's policies regarding assessments, therapy sessions, fees, cancellations, withdrawals, and other important matters. Parents must initial different sections to authorize the use of photos and indicate understanding of the policies.

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    Application Form 2017

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    This document is a registration form and guide to policies for Lighthouse Therapy and Education Centre. It requests information such as the child's name, date of birth, medical information, and emergency contacts. It also provides the centre's policies regarding assessments, therapy sessions, fees, cancellations, withdrawals, and other important matters. Parents must initial different sections to authorize the use of photos and indicate understanding of the policies.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    33 views4 pages

    Lighthouse Therapy and Education Centre: Registration Form

    Uploaded by

    Meliza
    This document is a registration form and guide to policies for Lighthouse Therapy and Education Centre. It requests information such as the child's name, date of birth, medical information, and emergency contacts. It also provides the centre's policies regarding assessments, therapy sessions, fees, cancellations, withdrawals, and other important matters. Parents must initial different sections to authorize the use of photos and indicate understanding of the policies.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 4

    REGISTRATION FORM

    Lighthouse Therapy and Education Centre


    Child’s full name: Unit B, 2nd Floor, La Residencia Building, 114 Maginhawa Street, Teachers
    Home Phone: Village East, Quezon City
    Nickname: WEBSITE: http://ltecph.wixsite.com/lighthouse Father’s name:
    FACEBOOK PAGE: ltecph,
    Child’s Date of birth: Email: [email protected]
    Place of Birth: Mobile
    Landline: (02) 239-1658 & 994-8896 Mobile No: number(s):
    09493645667
    Gender: Male Female
    Languages spoken: Occupation:
    Allergies: Company:
    Number of siblings: ____ Position of child: 1st 2nd 3rd or ____ Business Address:
    Home Address:
    Mother’s Name:
    Mobile number: Business Phone:
    E-mail Address:
    Occupation: Name of person(s) who will accompany
    Company: my child to & from the centre:
    Business Address: 1)
    Business phone: 2)

    If my spouse or I cannot be reached in case of an emergency, the following person may act as parent in place:

    Name:

    Address:

    Phone number:

    Should Lighthouse be unable to contact the parent in place, I give my permission to the staff of Lighthouse to seek medical assistance for my child.
    Signature of Parent: Date:

    AUTHORIZATION and CONSENT to photograph and publication


    From time to time, Lighthouse may wish to use photographs, movies or success stories regarding your child in order to promote our work. Therefore
    at the beginning of each programme year we seek parents’ permission to do so. Please read below carefully and kindly fill up, as you feel appropriate.

    I agree that Lighthouse Therapy and Education Centre may use the following details to assist with its public relations.
    Encircle any applicable choices.

    Photographs Name Story

    The term “photograph” as used above means motion picture or still photography, as well as video tape, video disc and any mechanical means of
    recording and reproducing images.

    Signature of Parent: Date:

    Programme preferences:
    LEAVE THIS PART FOR THE THERAPIST
    PROGRAMME 1 – (GS) Early Intervention Group Session for Ages 3 to 6 years old
    PROGRAMME 2 – (GS) Primary Group Session for Ages 7 to 12 years old

    Unit E, 2/F, 114 Maginhawa Street, Teachers Village East, Quezon City Phone: 239-1658 Mobile no: 09493645667

    E-Mail: [email protected] Web: http://ltecph.wixsite.com/lighthouse


    PROGRAMME 3 – (OT) Occupational Therapy Consultation

    PROGRAMME 4 – (OT) Motor & Coordination one to one session

    PROGRAMME 5 – (OT) Sensory Integration one to one session

    PROGRAMME 6 – (SLT) Speech & Language Therapy Consultation

    PROGRAMME 7 – (SLT) Speech & Oral Motor one to one session

    PROGRAMME 8 – (SLT) Using and Understanding Language one to one session

    PROGRAMME 9 – (OP) Outreach Programme Consultation

    PROGRAMME 10 – (OP) Literacy one to one session

    PROGRAMME 11 – (OP) Math one to one session

    PROGRAMME 12 – (OP) Arts and Crafts one to one session

    PROGRAMME 13 – (OP) Saturday Playgroup

    PROGRAMME 14 – (IM) Infant Massage mother and infant session

    PROGRAMME 15 – Language and Academic or Pre-Academic

    PROGRAMME 16 – Motor Skills and Academic or Pre-Academic

    Programme Day: Programme Time: Programme Fees:


    Signature of Parent: Date:

    LIGHTHOUSE THERAPY and EDUCATION CENTRE’S


    GUIDE to POLICIES, TERMS and CONDITIONS

    INITIAL ASSESSMENT
    Lighthouse values the child’s first meeting with us. This is vital in establishing the partnership between your child and the
    therapist. This gives us an overview of his/her current skills, capacity and helps us identify goals that are to be achieved
    and targeted during intervention.

    RE-EVALUATION
    The Lighthouse therapist may recommend a re-evaluation when previous goals have been met. You will be informed at
    least one week prior to the re-evaluation date (if needed).

    THERAPY SESSION
    1) Lessons will start and finish on time so please make sure you arrive promptly and arrange for your child to be
    picked-up after each lesson. No time extensions will be given if he/she is late for the session.

    2) In accordance with the DOST weather advisory and DepEd instructions, we do NOT hold classes when warnings
    for “Typhoon Signal Numbers 1, 2 or 3” have been raised. We regret that we cannot arrange make-up sessions for
    these or other enforced closures beyond our control. No refunds will be given for such cancelled lessons.

    3) Payments should be made in advance. All fees are non-refundable once the student has been accepted in the
    course.

    4) If your child will not be able to make it for the therapy session, here are the procedures to follow:
    A) Please inform us at least 24 hours before your child’s time & day of the therapy. There will be a 250
    PHP Retainer’s Fee charged per session if we are advised in less than 24 hours before therapy
    time, as lessons for that day were already prepared by the therapist.
    B) You must receive a confirmation from our office staff to ensure that we have received notice of your
    cancellation.

    5) Make-up classes will be provided for those who followed the advance cancellation procedures. On instances that
    the Lighthouse staff have not received prior notice of your child’s absence, there will be a penalty fee (refer
    below).

    6) Students will not be unfairly penalized for unsuccesful cancellation attempts that may have from internal
    communication problems or Lighthouse staff errors.

    NO SHOW PENALTY
    300 PHP shall be charged and collected the next session to cover for the therapist’s time and effort to have your child’s
    lessons prepared.

    RETAINER FEE (Applicable to Programmes 4, 5, 7, 8, 10, 11, 12, 15 and 16)


    For special cases that you would like to retain your child’s current schedule during long absences (if three or more
    consecutive sessions will be missed), kindly provide our therapist an advanced notice and please pay a RETAINER FEE
    of 250 PHP per session before the leave of absence. It will be the prerogative of your child’s therapist to assign the slot to
    another student if the aforementioned conditions are not met. Rest assured, you would be duly informed. Resumption of
    therapy sessions will depend on the availability of another therapy slot.

    EXTRA CHARGES
    A) Payment for Assesment, Application and Reservation are non-refundable.
    B) Reservation Fee is applicable for confirmed seats only.
    C) Outdoor activities - fees will be based on location and activity

    TYPHOON SIGNAL
    In accordance with Philippine practice, we do NOT hold classes when warning “Typhoon Signal” have been raised. The
    therapy centre will always base the suspension of classes from the Deped and/or Office of the Mayor’s advice. We regret
    that we cannot arrange make-up classes for these or other enforced closures beyond our control. NO REFUNDS will be
    given for such cancelled lessons.

    WITHDRAWAL FROM THE PROGRAMME for GROUP CLASSES


    If for any circumstances or reason(s) that your child is no longer able to continue with his/her therapy with us, may
    we request you to inform us 1 MONTH IN ADVANCE (of his/her last day). Failure to do so would obligate you to
    pay us 1 month’s worth of your child’s therapy fees and/or tuition fee.

    OTHER IMPORTANT MATTERS


    A) Lighthouse Therapy and Education Centre Co. and its staff will accept no responsibility for the loss or damage to
    a student’s property during sessions. Students, parents and guardians agree that no claims will be made against
    Lighthouse Therapy and Education Centre Co., its owners or its staff.

    B) We at Lighthouse Therapy and Education Centre Co. make no claims whatsoever that we are a DepEd registered
    school. We operate, as a S.E.C. and D.O.H. - recognized Therapy and Learning Centre that supports special needs
    children.

     These policies may be revised any time during the programme year. You will be informed in advance and will be
    provided with details accordingly.

    I, the parent/guardian have read and agree with the terms and conditions herein:
    Parent/Guardian’s Printed name and signature

    DATE

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