Application Form

Please complete this form so that we can open the file. Please do not hesitate to contact us if you have any questions.

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First name and Last name

Date of birth

School name

School year

Child’s main difficulties

Is the student involved in remedial education, speech therapy, occupational therapy, neuropsychology, etc.?

Any allergies or medical conditions/diagnoses?

Allergy to dogs?

File upload

Cliquez ou déplacez les fichiers vers cette zone pour les téléverser. Vous pouvez téléverser jusqu’à 10 fichiers.

Please upload all relevant documents. Maximum 10 Mb.

First name and Last name

E-mail

Address line 1

Address line 2

City

Province

Postal code

Cell phone

Other phone number to contact you

Emergency contact

Emergency contact telephone number

Questions or comments

Travaillons ensemble!