New Students

Submission of forms does not equate to acceptance in program.

A processing fee of $25 (which still must be sent by postal service, Fed Ex, etc.) must be received before your application will be considered.

If you are also submitting a video for assessment, your application will not be considered complete until the $100 video assessment fee (which still must be sent by postal service, Fed Ex, etc.) is received.

The Conductive Learning Center will notify you as to acceptance into the program.

Please click here for a printable version of this form.

Step 1 of 4

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  • Child's Personal Information

  • Please include names, ages and genders
  • Parent / Guardian Information

To provide opportunities for preschool and school age children with motor challenges to achieve optimal physical, cognitive and social independence through the application and promotion of conductive education principles.CLC is a 501(C)3 Organization