april break Vacation Services - Intake Form

Our clinic will be open for services during the 2017 April break. Students can sign up for any or all days, and one or both sessions offered each day (9am-12pm,12pm-3pm).  If you are looking for different hours, please let us know what will work for you, and we can work with you to accommodate your needs.  Our wonderful behavior therapists are available to carry over programming to our clinic setting to ensure your child will have no break from services, or to provide additional sessions to break up those long days at home while school is out.

**Please note, filling out this form does not guarantee enrollment. Our Clinic Manager or Intake Coordinator will be in touch to confirm your spot in the program.**

For help in filling out this form, or for more information about our vacation services, please contact info@abacs.org or call 617-505-6183.

Parent/Caregiver information
Person completing form *
Person completing form
e.g. parent, teacher, etc.
Student information
Student's Name *
Student's Name
Date of birth *
Date of birth
Preferred location *
Scheduling/Availability *
Please select all sessions that you are interested in.
Please let us know about any scheduling questions or concerns you may have related to the available session times.