Enrollment Information

Enrollment Eligibility

All children must meet the following entrance criteria:

Age between 2.5 - 5 years old

Age-appropriate nonverbal cognitive skills

With the exception of speech or language disorders, have no identified neurological disorders

Provide proof of up-to-date immunizations

Complete and submit required enrollment information

Independent toileting skills (for Preschoolers only).

As a member of the Rite Care Network of speech-language clinics and our ongoing affiliation with the Scottish Rite, and, because of the research done through the UA Dept. of Speech, Language, and Hearing Sciences, the school’s enrollment is limited to:

Children with normally developing language skills; AND

Children with developmental language disorder (DLD), phonological disorder, or speech delay/disorder.

We advocate for all young children, but we do not provide a comprehensive program to meet all special education needs.

We work to help families secure the best services for their children when needs are recognized that are beyond our scope of practice.

Children who require more than speech and language therapy services are referred to programs in our community. These include public school programs, and other community agencies that provide specialized services for young children.

TO ENROLL

Full or part-day, 4 or 5 days per week, Monday – Friday, for young children 2 ½ – 3 years old. This exciting, small group program emphasizes talking, listening and understanding.

Together with parents, each child’s strengths and needs are assessed and integrated into meaningful and appropriate activities. A team of two teachers and an ASHA certified speech-language pathologist nurture growth and development in small (6:1 ratio), active, developmentally appropriate indoor and outdoor learning environments.

Application/Enrollment forms Click Here

full or part-day, 4 or 5 days per week, Monday – Friday, for children 3 – 5 years of age. The preschool’s enriched language and literacy-based curriculum emphasizes oral language and social-emotional development, foundational for literacy and successful social interaction. Speech and language therapy services are an integral part of the WOW program. These are embedded into the preschool curriculum, as well as provided in one-on-one and small group sessions throughout the school day.

Application/Enrollment forms Click Here

Please download, complete and bring necessary intake forms to your first Wings on Words appointment. You can access these by clicking here. Or, when complete, these may be faxed in advance of your appointment to (520) 624-2947, or sent via postal mail to: 202 E. Speedway, Tucson, AZ 85705.
- If you prefer to email instead, please call us first, at (520) 628-1659 for secure email information.
Evaluation and therapy appointments for school-age children are scheduled in cooperation with the University of AZ Grunewald Blitz Clinic for Pediatric Communication Disorders (GBC). To schedule speech-language services for children 8 years-old and up, contact the GBC at (520) 621-7070.

APPLICATION 2023-2024

APPLICATION 2022-2023

SCHOLARSHIP APPLICATION FORM

WINGS ON WORDS SUMMER DAY CAMP

ALLERGY ALERT!

Child's Name(Required)

First Last

Is allergic to(Required)

Severity to allergy/ies:(Required)

Mild

Moderate

Severe

Treatment(Required)

Completed by (by printing your name, you are acknowledging the printed name on these documents will act as your temporary authorization and we will require you to sign the documents in person)

Completed by(Required)

Relationship(Required)

Signature

Date

Phone

This field is for validation purposes and should be left unchanged.

AUTHORIZATION FOR OBTAINING INFO

I, the undersigned, do hereby authorize the University of Arizona Speech Language and Hearing Clinics, on behalf of The Child Language Center, to obtain information from any agency or individual, as stipulated below, including pictures, audio or video tapes, who is or may be directly involved in the examination, treatment and/or recommendations concerning my child. I also understand that I have the right to revoke this authorization in writing at any time.

Child's Name*

First Last

Today's Date*

Home Address (include city, state, zip)*

Telephone*

Email Address*

This document is authorized by: (When initialing and printing your name, you are acknowledging the initials and printed name on these documents will act as your temporary authorization and we will require you to sign these documents in person):

Initials*

Printed Name*

Signature

Relationship to Child*

Address if different that Child*

Witness (Printed Name)

Date

The individual or agency listed below is authorized to release the client/patient information to:

The Child Language Center Wings on Words Toddler and Preschool Program

202 E. Speedway Blvd. Tucson, AZ 85705

Agency/Individual Name*

Address*

Type of Info to be released (ie: evaluation/progress reports, IEPs, etc)*

Agency/Individual Name*

Address*

Type of Info to be released (ie: evaluation/progress reports, IEPs, etc)*

Agency/Individual Name*

Address*

Type of Info to be released (ie: evaluation/progress reports, IEPs, etc)*

Phone

This field is for validation purposes and should be left unchanged.

AUTHORIZATION FOR RELEASING INFO

I, the undersigned, do hereby authorize the University of Arizona Speech Language and Hearing Clinics, on behalf of The Child Language Center, to release information as stipulated below, including pictures, audio or video tapes, to any agency or individual who is, or may be directly involved in the examination, treatment and/or recommendations concerning my child.

Today's Date(Required)

Client/Patient Name:(Required)

First Last

DOB:(Required)

Home Address:

Telephone:

Email Address:

Indicate Yes or No to permit or deny release of information:

Type of Info

1. Written:(Required)

Yes

No

2. Pictures:(Required)

Yes

No

3. Audio tapes/Digital Recordings:(Required)

Yes

No

4. Video Tapes/Digital Recordings:(Required)

Yes

No

Authorized by (By printing your name, you are acknowledging the printed name on this document will act as your temporary authorization and we will require you to sign the document):

Untitled(Required)

Signature:

Relationship to client/patient:(Required)

Address if different than client/patient:(Required)

Witness

Signature:

Email

This field is for validation purposes and should be left unchanged.

Best of Care

Child and Family Information Form

CONSENT FORM

The University of Arizona Speech-Language and Hearing Clinics are committed to protecting your health information. I have been given the Notice of Health Information Practices pertaining to how my personal health information will be used. As my child’s guardian, I have the right to request restrictions on the use of his/her health care information and can revoke this consent in writing at any time. I understand that I can receive a copy of my child’s initial report, therapy plans, and end-of-semester progress reports.

I understand that a role of this facility is as an educational training site for students in speech-language pathology and audiology. Evaluation and/or therapy could include the participation of student clinicians, parent observers, and other health care personnel.

I understand that my child’s speech and language objectives may be posted in his/her classroom and/or on stickers placed on his/her clothing to facilitate generalization in the classroom.

I consent to the release of my health information to be used for the treatment, payment and health care operations of the University of Arizona Speech-Language and Hearing Clinics.

Child's Name*

First Last

Parent/Guardian/Person authorized to consent*

First Last

(When printing your name, you are acknowledging the printed name on these documents will act as your temporary authorization and we will require you to sign the documents in person)

Signature

Signature of Parent/Guardian/Person authorized to consent

Date*

Signature of Parent/Guardian/Person authorized to consent

Yes, please contact me regarding information on programs and studies currently being offered by the Department of Speech and Hearing Sciences.*

Yes, please contact me regarding information on programs and studies currently being offered by the Department of Speech and Hearing Sciences.

Parent/Guardian/Person Name*

First Last

Signature

Signature of Parent/Guardian/Person Authorized to Consent

Date*

Comments

This field is for validation purposes and should be left unchanged.

Demographic Survey

This information is essential for us to describe the range of families that we serve in order to qualify for grants and tax credits. All information is completely confidential.

Year Attending WOW*

1. Enrollment Semester*

2. Child’s Age*

3. Gender*

4. Race*

6. Single Female Head of Household?*

Yes

No

7. Number of members in current Household?*

Income Level

a. Number of parents/guardians who are employed*

b. Combined annual income of all employed adults at home*

9. Did you apply for a scholarship?*

Yes

No

10. Were you awarded a scholarship?*

Yes

No

11. Are you in public service? (UA, Military, 1st Responders, Teachers)*

Yes

No

12. Where is your residence?*

13. Arizona Zip Code*

Email

This field is for validation purposes and should be left unchanged.

Drop Off / Pick Up Information

Child's Name*

First Last

Child’s Date of Birth*

Parent/Guardian’s Name*

First Last

Parent/Guardian’s Name*

First Last

The Following persons are authorized to pick up my child from The Child Language Center/Wings on Words Program. Photo identification will be required.

Person 1*

First Last

Phone No.*

Relationship to Child*

Person 2

First Last

Phone No.

Relationship to Child

Person 3

First Last

Phone No.

Relationship to Child

Person 4

First Last

Phone No.

Relationship to Child

Person 5

First Last

Phone No.

Relationship to Child

Routinely, I plan to drop off my child at (time)*

And will pick up my child at (time)*

Name (when printing your name, you are acknowledging the printed name on these documents will act as your temporary authorization and we will require you to sign the documents in person):

Name*

First Last

Signature

Date*

Email

This field is for validation purposes and should be left unchanged.

Emergency / Immunization Records

Enrollment Agreement

Wings on Words Preschool and Toddler Program

I agree to (please read and check each item)*

1. Have my child to school on time, no later than 8:30 am

2. Pick my child up on time or pay the late fee of $15.00 for each 15 minute interval

3. Keep current with your payments. Accounts that are past due after 14 days will becharged a weekly fee of 3% of balance due.

4. Attend parent/teacher conferences

5. Send my child to school only when he/she is healthy

6. Inform the school when my child is ill or absent

7. Complete 12 volunteer hours during the year

8. Direct my questions or concerns to my child’s teacher or to the directors

9. Read and follow the program policies and procedures detailed in the Parent Handbook

I understand that the following may be reasons for dis-enrolling my child:

Nonpayment of tuition
Behavior that endangers the child, other children, or staff member’s welfare or safety
Frequent or extended absences not associated with illness
A pattern of tardiness
Failure to sign your child in and out
Failure to follow school policies

My signature below indicates I have read the above items. In addition, my signature acknowledges I have received a copy of the Parent Handbook, electronically or a hard copy. (When printing your name, you are acknowledging the printed name on the document will act as your temporary authorization and will require you to sign the document in person).

Name*

First Last

Date*

Parent/Guardian*

First Last

Signature

Parent/Guardian

First Last

Signature

Email

This field is for validation purposes and should be left unchanged.

Helping Hands Make For Easy Work

School Information Inquires

Today’s Date*

How did you hear about WOW*

Parent/Guardian Name*

First Last

Email address

Mailing address*

Parent/Guardian Name*

First Last

Email address

Mailing address*

City*

State*

Zip Code*

Relationship to Child*

Child’s Name*

First Last

Child Birthdate*

Gender*

Home Phone*

Work Phone

Cell Phone

May We Email?*

Yes

No

Wants info on*

Hours of Care needed*

Toileting*

Currently Attends School at*

Recieves Speech Therapy?*

Yes

No

Speech Location

Are you a Public Service Employee Ie: Fire Dept., Police dept., U of A Student*

Yes

No

Are you DES Eligible?*

Yes

No

Click and Let us know more about your child*

Email

This field is for validation purposes and should be left unchanged.

Sunscreen Permission Form

By signing below, you are permitting a sunscreen product of SPF 15 to be applied to your child’s bare skin surfaces including, but not limited to, the face, tops of the ears, nose, and bare shoulders, when outdoor activities in direct sunlight are scheduled.

Today’s Date*

Child’s name*

First Last

Date of Birth*

Does your child have any known allergies to sunscreen products?*

Yes

No

If yes, please explain:

Does your child have any known allergies to sunscreen products? Answer*

Authorized by (when printing your name, you are acknowledging the printed name on these documents will act as your temporary authorization and we will require you to sign the documents in person)*

Authorized by (when printing your name, you are acknowledging the printed name on these documents will act as your temporary authorization and we will require you to sign the documents in person)*

First Last

Relationship to child*

Signature

Date*

Phone

This field is for validation purposes and should be left unchanged.

Family Size	2	3	4	5	6	7	8
200% of FPL	$31,460	$39,580	$47,700	$$55,820	$63,940	$72,060	$80,180

Enrollment Information

Enrollment Eligibility

TO ENROLL

Applications & Fees

Applications

Fee schedule

Enrollment forms

Emergency Info and Immunization Record

Reviews and Ratings
as posted on GreatNonprofits.org

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