New Customer Registration Form

New Customer Registration Form
Customer Details:
Full Name

First NameLast Name
Kiddos Name(s)/Preferred Name(s)

First NameFirst Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
How did you hear about us?
Please Specify
Any Accommodations You May Need for This Social:
Additional Info (questions you might have, important information about your kiddo(s):
Please Select the Date of the Class(s) You Will Be Attending

MonthDayYear
Date
Please Select the Date of the Class(s) You Will Be Attending

MonthDayYear
Date
Classes
prevnext( X )
Parent Training
Our 1 hour group setting parent training offers practical strategies & expert guidance in navigating behavioral health at home & school. We cover topics such as; evaluation help, behaviors, community resources & much more

$20.00



Peer to Peer Socials
Embark on a journey with our 1 hour peer to peer socials. With parents by their side, kiddos can thrive in an inclusive environment with open gym, dramatic play, arts & crafts & games fostering friendships & confidence the entire way

$20.00



DIY Sensory
Discover the joy of sensory exploration with our 1 hour DIY Edible Sensory socials. Together with parents, kiddos can delve into a world of edible creations, enhancing fine motor skills while indulging their senses. From edible arts to tasty treats, every session promises delightful discoveries & memorable moments to take home

$20.00



Parent Training 1:1
Our 1 hour parent training offers practical strategies & expert guidance in navigating behavioral health at home & school. This service is catered to the specific needs of your kiddo.

$20.00



Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

New Customer Registration Form

Classes

Payment Methods