Skip to main content
twitter
facebook
pinterest
linkedin
youtube
google-plus
yelp
Blog
We Travel To You!
347-394-3485
917-426-8880
Text: 917-426-8880
info@brooklynletters.com
Hit enter to search or ESC to close
Close Search
search
Menu
Literacy Tutoring |
Staff
Evaluations
In-person
Remote
Writing
Handwriting
Orton Gillingham
Wilson/Fundations
Reading Comprehension
Decoding & Encoding
Spelling
Reading Fluency
Math Tutoring |
Staff
Remote Evaluations
Tutoring K-5
Speech Language – Pediatrics |
Staff
Evaluations
Speech & Language
Feeding Evaluations
Literacy Testing by Language Therapists
Pronunciation/Enunciation/Articulation
Expressive Language Disorder
Early Childhood Expressive Language
School Age Expressive Language
Developmental Language Disorder
Writing & Speaking Therapy
Listening Comprehension
Comprehension- Listening & Reading
Vocabulary
Teens – Language Therapy
Stuttering
Feeding
Auditory Processing
Oral Motor
Voice
AAC
Speech Language- Adults |
Staff
Public Speaking
Accent Reduction Modification Speech Therapy
Stuttering
Additional Services |
Special Education Itinerant Teacher – SEIT
Deaf Hard of Hearing
Handwriting
About Us
Testimonials
Rates & Billing Policies
Contact Us
search
Home
»
Parent Forms
Brooklyn Letters COVID-19 Reopening - Speech Language Therapy
Pursuant to recent orders, Brooklyn Letters is able to resume in-person speech-language therapy. Please complete this form for EACH of your children who will receive in-person services by a Brooklyn Letters Speech Language Pathologist, even if that child has received in-person services at a previous time. COMPLETE A SEPARATE FORM FOR EACH CHILD RECEIVING SPEECH SERVICES. DO NOT INCLUDE MORE THAN ONE CHILD ON EACH FORM.
State your Full Name.
*
What is today's date?
*
MM slash DD slash YYYY
State your Child's Full Name and DOB.
*
What is the name of the Brooklyn Letters Speech Language Pathologist who is working with your child?
*
Please read the attached Waiver and Release of Liability and verify that you have read it in its entirety and agree to its terms.
*
Yes, I have read the attached Waiver and Release of Liability and agree to its terms in its entirely.
Yes, I have read the attached Waiver and Release of Liability but DO NOT agree to its terms in its entirety.
No, I have NOT read the attached Waiver and Release of Liability.
Waiver and Release of Liability Page 1 of 2
Waiver and Release of Liability Page 2 of 2
Please read the attached COVID-19 Reopening Safety Plan and verify that you have read it in its entirety and will abide by its provisions.
*
Yes, I have read the attached COVID-19 Reopening Safety Plan and will abide by its provisions.
Yes, I have read the attached COVID-19 Reopening Safety Plan but will be unable to abide by one or more of its provisions.
No, I have NOT read the attached COVID-19 Reopening Safety Plan.
COVID-19 Reopening Safety Plan Page 1 of 4
COVID-19 Reopening Safety Plan Page 3 of 4
COVID-19 Reopening Safety Plan Page 4 of 4
If you WILL NOT be able to abide by one or more of the provisions of the COVID-19 Reopening Safety Plan, please state which such provisions.
I hereby consent to my typed signature below to act as an electronic signature for the Waiver and Release of Liability and COVID-19 Reopening Safety Statement included herein.
*
Yes
No
Type Full Name as Electronic Signature
Δ
FORMS
Parent Waiver Speech Therapy
Parent Waiver Tutoring
Close Menu
Literacy Tutoring |
Staff
Evaluations
In-person
Remote
Writing
Handwriting
Orton Gillingham
Wilson/Fundations
Reading Comprehension
Decoding & Encoding
Spelling
Reading Fluency
Math Tutoring |
Staff
Remote Evaluations
Tutoring K-5
Speech Language – Pediatrics |
Staff
Evaluations
Speech & Language
Feeding Evaluations
Literacy Testing by Language Therapists
Pronunciation/Enunciation/Articulation
Expressive Language Disorder
Early Childhood Expressive Language
School Age Expressive Language
Developmental Language Disorder
Writing & Speaking Therapy
Listening Comprehension
Comprehension- Listening & Reading
Vocabulary
Teens – Language Therapy
Stuttering
Feeding
Auditory Processing
Oral Motor
Voice
AAC
Speech Language- Adults |
Staff
Public Speaking
Accent Reduction Modification Speech Therapy
Stuttering
Additional Services |
Special Education Itinerant Teacher – SEIT
Deaf Hard of Hearing
Handwriting
About Us
Testimonials
Rates & Billing Policies
Contact Us
twitter
facebook
pinterest
linkedin
youtube
google-plus
yelp