Apply For Enrollment

Child's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

Mother's Name

First Name

Last Name

Father's Name

First Name

Last Name

Phone *

(###)

###

####

Date Needing Care *

What is the earliest you would like to start your child at the Goldman Schools?

MM

DD

YYYY

What Services is your child currently receiving? (Check all that apply)

Physical Therapy (PT)

Occupational Therapy (OT)

Speech (SLT)

Applied Behavior Analysis (ABA)

Early Steps (Children under 3 years old)

Caddo Parish Special Services (Children over 3  and older)

How did you hear about us?

I saw an ad on Facebook

I saw an ad on Instagram

A friend / relative told me about it.

I saw a billboard.

I heard about it an other way.