Website summer contact form

Summer Sign up Form
We look forward to working with you this summer. Please complete the form below and we will contact you to discuss the best summer program for your child.
Full Name *

First Name Last Name
E-mail *
Phone *
What is the best way to reach you?

Call Email
Child's Name *

First Name Last Name
Child's Age *
Current Grade
Child's School
Areas of Concern

Reading Dyslexia Writing Math Auditory Processing Attention Executive Functioning Processing Speed Flexible Thinking Other
If other, please describe
Any other information?
I am interested in:

Summer Intensive Summer Custom Schedule Not Sure Yet
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The K&M Center, Inc. is located at:

3435 Ocean Park Blvd., Ste 210, Santa Monica, CA 90405.
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Summer Sign up Form