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     BRAIN CAMPS
    2012 BRAIN CAMP APPLICATION

     Application

    Advanced Learning and Development Institute

    613 Bryden, 104

    Lewiston, Id 83501

    714-575-0001 866-812-7246

    brainadvance@gmail.com

     

    Parents’ Name_______________________________________________________

    Client Name________________________________________________________

    Address____________________________________________________________

    City_____________________State_________________________Zip_ _________

    Phone_____________Work Phone______________Cell Phone________________

    E Mail:_____________________________________________________________

    Clients age__________Areas of concern_____________________________________________________

    __________________________________________________________________

    __________________________________________________________________

    __________________________________________________________________

    Previous therapies ___________________________________________________

    __________________________________________________________________

    __________________________________________________________________

    __________________________________________________________________

    Currently have or had in past:


    _______sinus infection

    _______frequent colds

    _______swimmers ear

    _______tubes in ears

    _______plugged or hurting ear/s

    _______allergies causing stuffed up nose or ears

    _______itchy ears

    _______tendency to wax build up in ears

    _______hearing loss

    _______ear infection (even 1-2 ever is significant)


    Session attending, 1st choice:_____________________ (based on availability)

    2nd choice for session            _____________________

    Deposit  ______________ enclosed minimum deposit $1500 to accompany application, and  $1000.total deposit $2500)Due at beginning of session, if choose payment plan  Otherwise full payment ($6900) due at first session.  Master card and visa also accepted. Call for arrangements if payment plans are needed and for cost of your full program.

    CC:_____________________________________/Exp________

    Signature_________________________________

    Make Checks payable to Advanced Learning & Development Institute

     Upon receipt of this application:  Your acceptance will be confirmed and your registration paperwork sent to you.

     2012 Brain Camp Schedule 

    Advanced
    Learning & Development Institute Program Schedule
    2012

    12 day Intensive Session Dates

    March 23rd – April 3rd

    June 11th - 23rd

    July 7th- July 19th


    **DATES SUBJECT TO CHANGE--PLEASE CALL BEFORE MAKING ANY FINAL PLANS!!**
     
    Call today to schedule the program date that works best for you:
    866-812-7246 (866-81-brain)  
    714-575-0001
     

    This year we have added a day in the beginning for parent training and orientation. Plan on arriving 1-2 days prior for testing of client.

     

    e-mail: brainadvance@gmail.com

    www.brainadvance.org

     

    NOTE: Brain camps are in central, Idaho at a ranch.  Lodging and meals available.

    Site Mailing List  Sign Guest Book  View Guest Book 
    Raising the Standard of Human Development 866-812-7246, 714-575-0001

    Advanced Learning &
    Development Institute

    866-81-BRAIN
    714-575-0001
    brainadvance@gmail.com

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     Testimonials
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    Lizbeth Autism Testimony
    Robin M. - success in 12 days, nutrition before & after