Follow the steps to complete the application process.

1. Click the ‘Get Form’ button to access the application form. This will allow you to download and open it for editing.
2. In the client information section, fill in your child's name, date of birth, age, and gender. Next, provide the parent's name(s), address, city, state, ZIP code, phone number(s), and email address. Include the pediatrician's name or medical doctor as well as how you heard about the Kaufman-Apraxia Boot Camp at The Carruth Center.
3. Move on to the school information section. Indicate whether your child is currently attending school by selecting 'Yes' or 'No'. If yes, provide the school name, address, and phone number.
4. In the therapy history section, answer if your child is currently receiving individual speech therapy. If so, include the name of the speech-language pathologist or therapy company, their phone number, and email. State how long your child has been seeing this therapist. Specify if your child has been diagnosed with Childhood Apraxia of Speech, including who made the diagnosis and when.
5. If applicable, provide information on any other speech-language pathologists your child has seen since the diagnosis, along with their contact information. Address other developmental diagnoses your child may have, and list any additional therapy services your child receives by checking the relevant boxes.
6. At the end of the application, review and complete the consent agreement regarding understanding the application process and conditions. Ensure both parents or legal guardians sign and date the form where indicated.
7. Once you have filled out the form thoroughly, submit it along with the $40 application fee and your child’s most recent speech-language evaluation to The Carruth Center by the specified deadline. Make sure to save your changes and keep a copy for your records.

Start your application process online today and take the first step towards securing a spot in the Kaufman-Apraxia Boot Camp.