Sensory and Social Saturdays

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Sensory & Social Saturdays
Select you start Date*

MonthDayYear
📢 All sessions require a minimum of 24 hours’ notice. Registrations received within 24 hours of the session cannot be accommodated and will be moved to the following week. No exceptions.
Weekly (90 min Session)Drop in (60 min Session)
Saturdays, 11:00 AM -12:00 PM
Saturdays, 11:00 AM -12:30 PMSaturdays, 1:30 PM - 3:00 PM
1 - Student's Full Name *

First NameLast Name
2 - Student's Date of Birth *

MonthDayYear
Date of Birth
Grade*
Schedule your 1 on 1 intro meeting with RBT to discuss your child's needs
PARENT INFORMATION
Mother Full Name *

First NameLast Name
Mother Email *
example@example.com
Mother Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Father Full Name *

First NameLast Name
Father Email *
example@example.com
Father Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Address *

Street Address

Street Address Line 2

CityState

Zip Code
PAYMENT

Weekly:Sensory & Social Saturdays

Billed Monthly ($180/month)

$180.00

Drop In: Sensory & Social Saturdays

One Time

$35.00

Enter coupon

Total

$0.00

Enrollment Agreement

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Signature*

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Date of Consent*

MonthDayYear
Date
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