Cycle Registration Form

Parents must register for their child’s therapy for each Cycle. Once reviewed, Tracy Pierce Bender will email the parent to confirm their schedule. Please note, requested schedules are not guaranteed until Tracy confirms them.
Registration forms are due December 1st for the spring cycle, May 1st for the summer cycle and August 1st for the fall cycle. The registration fee of $50 will be waived for all who turn in their registration form on or before the due date.Schedules will be approved in the order in which they were received. Please email yurmea@woodallkids.org if you have any questions.

Child's Code

Child's Name

Date of Birth (mm/dd/year)

Mother's Name

Father's Name

Home Address (include city, state, zip)

Phone Number

Your Email

Registering for:

What programs is your child involved with?
AcademyBLIPCALSIIPPALSPREPTIESSocial/Language groupNot sure

Your preferred Schedule Options:
*Please note that PALS and TIES students may only come from 2:00 to 6:00 PM on week days. Any request that falls outside of these hours will be denied.
*There is limited availability on Saturdays. If the BWF cannot schedule your child on a Saturday, the BWF will use your alternate schedule option or contact you.
*If your child is only attending for group sessions, please choose Not Applicable below and the BWF will contact you regarding the appropriate group and schedule.

(hold down CTRL to select multiple options)

MONDAY                       TUESDAY                       WEDNESDAY                  THURSDAY                       FRIDAY


SATURDAY

Preferred Schedule to Start (mm/dd/yy)

Your Alternate Schedule Options
*Please note that PALS and TIES students may only come from 2:00 to 6:00 PM on week days. Any schedule request that falls outside of these hours will be denied.
*There is limited availability on Saturdays. If the BWF cannot schedule your child on a Saturday, the BWF will use your alternate schedule option or contact you.
*If your child is only attending for group sessions, please choose Not Applicable below and the BWF will contact you regarding the appropriate group and schedule.

(hold down CTRL to select multiple options)

MONDAY                       TUESDAY                       WEDNESDAY                  THURSDAY                       FRIDAY


SATURDAY

Alternate Schedule to Start (mm/dd/yy)

Please include any additional information or conflicts such as vacation time or doctor appointments you would like the BWF to know regarding your child's schedule.

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Download Client Policies


I understand that the Brent Woodall Foundation (BWF) may not be able to accommodate all preferred schedules, but will do everything it can to use my preferred schedule. I understand schedule requests will be given priority by the order in which they are submitted. I understand that if my preferred schedule does not work, the BWF will use a combination of my preferred and alternate schedule. I understand that I will be charged a $50 registration fee if my schedule is turned in after the cycle registration deadline or without 30 days notice. I understand that the BWF will contact me with my child's schedule approximately two weeks prior to start of the new cycle. I have read and understand the BWF Client Policy Agreement.

Type Electronic Signature

Today's date (mm/dd/yy)