Los Angeles Speech and Language Therapy Center, Inc.

5761 Buckingham Parkway, Culver City, California 90230

310-649-6199

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Say N' Play Camp

Say N' Play Registration

Child:
First Name
Last Name
Date of Birth

PARENT/GUARDIAN:
First Name
Last Name
Address
City
State/Province
Zip/Postal Code
Home Number
Work Number
Email Address

PERSON RESPONSIBLE FOR PAYMENT:
Full Name
Regional Center Service Coordinator

Copyright © 2009 Los Angeles Speech & Language Therapy Center, Inc. All rights reserved.