ABA Summer Intensive Program 2025 Registration

ABA Summer Intensive Program 2025 Registration
Child's Name*

First NameLast Name
MaleFemale
Date of Birth*

DayMonthYear
Date
Address
Mother*

NamePhone Number
Father*

NamePhone Number
Contact Email Address*
example@example.com
Toileting*

Fully independentNeeds reminders/helpNot toilet trained
Dressing & Undressing*

Fully independentPartial helpNeeds full support
Hand washing*

Fully independentNeeds assistanceAvoids or refuses
Follows instructions*

ConsistentlySometimesRarely
Social Interaction*

Seeks out peersLimited interactionLimited or no play
Behavioural Challenges*

NoneMild (occasional)Moderate (weekly)Severe (daily/multiple times a day)
Crying/Screaming*

RarelySometimesFrequently
Flopping/Dropping to Floor*

RarelySometimesFrequently
Aggression (to self or others)*

NoneMild (e.g., pushing)Moderate (e.g., hitting/kicking)Severe (injury-causing)
Sensory Sensitivities*

Not observedMild (e.g., dislikes loud noises)Moderate/Severe (e.g., meltdowns)
Transitions (e.g., changes in routine)*

Handles wellNeeds warnings/prepBecomes upset or resistant
Academic Readiness (if applicable)*

Not ApplicableOn trackNeeds support with focus or tasksAvoids or refuses learning activities
Attention and Focus*

Can focus for age-appropriate timeEasily distractedVery limited attention spanDoesn’t seat still
Dietary Requirements*
Medication (Name, Dose, Time and Specific Instructions)*
Medical Condition ( Health Issue, Reaction and Medical Response Required)*
Drop off / collection from TDCC *

NamePhone Number
Relation to the child*
Emergency Contact*

NamePhone Number
Language spoken at home*
First language*
Type of program*

Mainstream EducationSpecial Education
Services Received at School (if any):*

Resource RoomTherapy1:1 Learning Support / ShadowOther
Does your child see any health professionals?*

YesNo
If yes, type of health professional*
How is your child's behavior at nursery / school?*
How is your child behavior at home?*
How do you manage the behaviors?*
What would you like us to focus on during the program?*
List of preferred activities? *
List of activities to avoid? (messy play , water play , bubbles, etc)*
Please check your registration options (Minimum of 3 weeks)*

Week 1 (Jul 07th to Jul 11th)Week 2 (Jul 14th to Jul 18th)Week 3 (Jul 21st to Jul 25th)Week 4 (Jul 28th to Aug 01st)Week 5 (Aug 04th to Aug 08th)Week 6 (Aug 11th to Aug 15th)
Preferred Timing*

Morning Batch: 9:00 AM – 1:00 PMAfternoon Batch: 2:00 PM – 5:00 PM
What's included:

Focused 4-hour ABA sessions daily
2 BCBA supervision sessions
1 parent training session
Individualized goals & small group setting (2:1 ratio)
Personalized end-of-camp progress report

Please note:
Minimum Registration: 3 weeks
Weekly Rate: AED 2,300

Terms and conditions: Fees are due within five days of receipt of registration. This fee is not refundable.
How did you hear about the program?*
Name and Signature*
By signing, I hereby agree to the terms and conditions and confirm the details I have filled out.*

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