Cycle Registration Form

The Brent Woodall Foundation provides therapy year-round, within a 3 Cycle format.

  • Winter Cycle: January – May
  • Summer Cycle: June – August
  • Fall Cycle: September – December

Parents must register for their child’s therapy for each Cycle. When completing the registration form, parents will indicate their top 2 preferred session schedules. No schedule is guaranteed; therefore, it is required an alternate schedule be provided. Sessions are given out on a first-come, first-served basis. Once reviewed, parents will receive an email confirmation of their approved schedule. Please note, the requested schedules are not guaranteed until they are confirmed by Nicki via email.

Changes in insurance authorization may require changes in schedule and those changes will be made accordingly. 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.

Any forms turned in after the due date will incur the $50 registration fee. Please turn in the registration form via email to n.scott@woodallkids.org. Please do not turn them into any staff members. Any schedule changes that occur without 30 days notice will incur the Registration Fee of $50.

Note:

  • All accounts must be up to date and paid in full before schedules will be confirmed.
  • Sessions are scheduled by the hour. We do not provide half-hour sessions.
  • Sessions are available Monday-Friday 8:00 am-6:00 pm.

    Cycle Registering for:

    Winter (Jan- May)Summer (June- Aug)Fall (Sept- Dec)

    Child Name - First and Last

    Child Code

    Child's Date of Birth:

    Mother's Name - First and Last

    Mother's Email

    Mother's Phone Number

    Father's Name - First and Last

    Father's Email

    Father's Phone Number

    Primary Phone Number:

    MotherFather

    Home Address

    City

    State

    Zip

    _____________________________________________________________________

    Preferred Schedule

    1:1 ServicesSocial GroupConsultation

    Monday:

    Monday Start Time

    Monday End Time

    Tuesday:

    Tuesday Start Time

    Tuesday End Time

    Wednesday:

    Wednesday Start Time

    Wednesday End Time

    Thursday:

    Tursday Start Time

    Tursday End Time

    Friday:

    Friday Start Time

    Friday End Time

    Schedule to Start:

    _____________________________________________________________________

    Alternate Schedule

    1:1 ServicesSocial GroupConsultation

    Monday:

    Monday Start Time

    Monday End Time

    Tuesday:

    Tuesday Start Time

    Tuesday End Time

    Wednesday:

    Wednesday Start Time

    Wednesday End Time

    Thursday:

    Tursday Start Time

    Tursday End Time

    Friday:

    Friday Start Time

    Friday End Time

    Schedule to Start:
    _____________________________________________________________________