Aquatic Therapy Interest
We will let you know when Aquatic Therapy groups are forming (Christmas Break, Spring Break, Summer)
What groups are you interested in?
Christmas Break Aquatic Camp 2024
Spring Break Aquatic Camp 2025
Summer Break Aquatic Camp 2025
All Aquatic Camps
How did you hear about us and these groups?
Social Media/Online search
Therapist referral
Monthly Newsletter
Physician Referral
Other
Has your child participated in Aquatic Therapy before?
Yes, at We are Better Together
Yes, at another facility
No, this would be our first time
Your Child's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Primary Diagnosis/Needs
Caregiver/Parent Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Best way to contact you
Email
Phone
Other
Best time for group
Morning
Afternoon/after school
Evening
Weekend
Other
What do you hope to gain from the group(s)?
Submit
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