Advance Registration 2024
Submit the form below and a member of our team will be in touch with you.
Parent / Guardian Name
*
First Name
Last Name
Child's Name
*
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
Please tell us about your areas of concern or child's diagnosis.
How many total sessions would you like to attend throughout the year?
1
2
3
4
What is your preferred location?
Fitchburg, Wisconsin
Wausau, Wisconsin
Select up to 5 date prefrences
*
November 27-December 22, 2023
January 2-26, 2024
January 29 - February 23
February 26 - March 22, 2024
April 1-26, 2024
April 29 - May 24, 2024
June 10 - July 5, 2024
July 8 - August 2.2024
August 5 - August 30, 2024
Are you interested in signing up for the Advance program (intensive physical/occupational therapy), or AACcelerate program (intensive AAC), or both?
Please Select
Advance
AACcelerate
Both
Comments
Do you have any special interventions you would be interested in including with Advance?
Dynamic Movement Intervention (DMI)
Occupational Therapy
Constraint-Induced Movement Therapy (CIMT)
Speech Therapy
Other
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type a question
Submit
Should be Empty: