Haven 2025 Registration

2025 Intensive Registration
This form provides us with initial information to determine eligibility, location, timing, and program needs. Once recieved, a team member from Haven Kids Therapy will reach out to you to discuss next steps for confirmation of registration.

Haven Kids practitioners are highly trained in a variety of modalities, such as Dynamic Movement Intervention (DMI), Therasuit methodology, Theratogs, Whole Body Vibration, Neuromuscular Electrical Stimulation, Reflex Integration, and more.

We do not have a clinic location. The HKT team commutes to homes within an hour radius of Gainesville, Georgia. If you are located outside of those boundaries, you can still participate! We partner with a local nonprofit called Love Your Story that aids in housing for families seeking intensive therapy in our city. If using this service, then HKT will commute to Molly's House (provided through LYS) in Gainesville to conduct therapy.
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Caregiver Name

First NameLast Name
Address*

CityState

Zip Code
Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
YesNo
PhoneTextEmail
Diagnosis or reason for seeking intensive therapy services?
What are some goals you are wanting to work towards?
OTPTSpeech
YesNo
Yes (Love Your Story will be contacting me for further information and booking)No, we will be commuting
January 6-24February 3-14February 17-28March 3-14March 17-28April 7-25May 12-30August 4-15August 18-29September 8-19September 29-October 10October 13-24November 3-12December 8-19
Any questions or concerns?
I was referred by:
Leave blank if not referred by anyone
Completion of this form does not gaurantee placement. Haven Kids Therapy will be contacting you to discuss further details and to confirm participation.

A $1000 deposit will be required in order to confirm your spot as we base much of our availability off of session location. The remaining balance will be due at the start of the program. Please provide any grant or funding information that you plan to use, if any, during your formal booking communication.

We are not in network with any insurances in order to best tailor our programs to serve each client's needs. The total program cost is based on a simple hourly rate and is dependent on the number of days/weeks you wish to participate. We recommend a minimum of 2 weeks (2 hours per day), with more optimal results seen at 3 weeks. We are able to provide superbills for families who are interested, as well as aid in any grant submission requirements. We are able to accept cash, check, venmo, and zelle as payment options.

We look forward to serving your family!
Should be Empty:

2025 Intensive Registration