Family Program Enrollment Form

The Family Program ($695)

Please check back tomorrow. We are in the process of changing our site to offer people more Family Program options, which also means different payment options. We apologize for any temporary inconvenience (but we are confident that families will appreciate the different ways they will now be able to do the Family Program).

Parent's First Name

Parent's Last Name

Child's name

2nd child's name

3rd child's name

I have read the Famly Program's "What You Need to Know" page.

Select One (USD) Payment Option

2 adults and 1 child - $695

2 adults and 2 children - $890

2 adults and 3 children - $1085

After payment is accepted, you will receive two separate emails. One email confirms your payment transaction. The other email provides directions on how to set up an account.

If for some reason, you do not receive either email, please check your spam folder. If it is not there, please notify us immediately by email at contact@brainhighways.com.

Child's age

2nd child's age

3rd child's age