Emergency Contact, names and cell phone numbers (please list 2):
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Which program(s) are you enrolling for?
Please list any allergies
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What skills would you like your child to improve on during this experience?
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What types of incentives motivate your child?
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What are your child's favorite play activities?
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Please list any medical diagnosis your child has:
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Is there anything else you would like us to know that may be helpful in working with your child?
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How will you be providing your $50 deposit to hold your spot?
Clear selection
I understand that this program is not appropriate for students with significant cognitive delays, significant oppositional/defiant behavior, and/or a history of aggression or high likelihood of aggression. *
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Do you have any other questions for us?
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A copy of your responses will be emailed to the address you provided.