Lacey Nelson | Dynamic Therapy Specialists

Lacey, a Zachary native, earned her master’s degree in occupational therapy from the University of St. Augustine for Health Sciences in Austin, TX. She has years of experience working with children. She enjoys being a significant part of their journey to help them gain the skills and techniques to improve their performance in meaningful occupations.

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Wow Yoga Registration Form

STUDENT INFORMATION
Name*
First MI Last
Home Address*
Street Address Address Line 2 City State ZIP Code
Class Location*
Specify Classroom Child Is In*
Home Phone
Cell Phone
Email*
For Confirmation / Reminder
CONTACT INFORMATION
Parent / Guardian Name*
First Last
Home Phone
Work / Cell Phone
Emergency Contact Name
Relationship to Student
Emergency Phone
Alternate Phone
Do you give permission for Dynamic Therapy Specialists, LLC. to use pictures taken of your child during yoga for Marketing purposes?*
- Yes
- No
To pay by CHECK:
Amount
Check #
To pay by Paypal: email address you'd like invoice sent to

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Be Part Of Our Team

Teletherapy Options - Registration Form

Name
First Last
Email
Phone
Address
Street Address Address Line 2 City State ZIP Code
Teletherapy Options*
- Pediatric Speech and Language Therapy
- Auditory Processing Therapy
- Reading and Writing Intervention
- Wow for Focus and Attention
- WOW Yoga for Kids
- Booster Club
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Lacey Nelson, MOT

Occupational Therapist

CONTACT

CALL US

ADDRESS

EMAIL

STUDENT INFORMATION

CONTACT INFORMATION

To pay by CHECK:

Parents Information

RELEASE AND INDEMNITY AGREEMENT