Summer Camp Registration Form

Summer Camp Registration Form

June 1st-August 7th at the 123 ABA Center, M-F 10am-2pm.
Participant Full Name

First NameLast Name
Parent Email Address
example@example.com
Parent Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Participant Date of Birth

MonthDayYear
Date
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Weeks Attending:
Please list any medical conditions or allergies
Our camp is designed to be an inclusive environment and is open to children of all abilities. We strive to provide a safe, supportive, and successful experience for every camper.

To ensure that all children can participate safely and meaningfully, we continually assess each child’s support needs throughout camp. If, at any time, we determine that a child requires individualized 1:1 support due to behaviors that impact their safety, learning, or ability to participate in the group setting, 123 ABA reserves the right to require 1:1 support as a condition of continued participation in camp.

Should 1:1 support become necessary, services would be provided at our standard ABA rates. Prior to implementing any additional support, we will discuss our recommendations with you, review the available options, and determine the most appropriate plan to ensure your child can safely and successfully participate in camp.

If you’re unsure whether the camp environment will be the right fit, you’re welcome to schedule a trial day. We offer a prorated single-day camp option for $100 per day, which allows us to observe your child’s support needs while giving them an opportunity to experience camp before committing to additional days. To schedule a trial day, please email info@123abatampa.com
I understand that the cost of Summer Camp is $500/week and will be billed weekly via AutoPay. I agree to 123 ABA Services, LLC's rules and policies.
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