See You Thru Speech Screening

Date of Screening: Friday 21^st October 2022

Child's First Name

Child's Surname

I give permission for my Child to be assessed by a member of Staff from See You Thru Speech Pathology at Teenie Weenies Learning Centre. I understand that the Payment of $35 is to be made prior to my child’s screening.

Payment Option

I give permission for Teenie Weenies Learning Centre to Debit $35 from Hubworks Please find Cash payment of $35 enclosed

Share Information

I give Permission for See You Thru to share my child’s report with Teenie Weenies Educators.

Parent's First Name

Parent's Surname

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Date