Register Your Interest Form

1

What is your Name?

First Name

Last Name

2

What is your child's Name?

First Name

Last Name

3

How old is Your Child?

4

Please provide your E-mail address* This field is required.

5

Please provide your contact number * This field is required.

6

The following services are based at our Walsall CentreWhich of the following are you interested in?

Holiday Club

Weekend club

After School Club

ABA Inspired Group Sessions

1 to 1 ABA Inspired Therapy Sessions

1 to 1 ABA parent Consultation

ABA Group parent workshop

None

Other

7

We run Holiday clubs from the following schools:Please let us know if you are interested in your child attending any of the following locations

Wilson Stuart School, Birmingham B23 7AT

Brays School, Birmingham B26 1NS

Calthorpe School, Birmingham B12 0TP

8

Details About Your Your Child's Needs: Feel free to share any relevant details, e.g., child’s needs, preferred days/times, or specific services.