Child's Information

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Date of Birth *

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Parent/Guardian Information

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Emergency Contacts

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I want to enroll my child in (check all that apply) *

Session 1: June 6 - June 17; $600

Session 2: June 20 - July 1; $600

Session 3: July 5 - July 22; $700

I attest that I am the legal guardian of this registrant and as such have the authority to consent to treatment and the release of information for this individual. I agree to notify Great Heights ABA, Inc. of any change in my status as legal guardian.

I understand that I will be billed for Summer Camp Sessions as indicated above sent to the email I provided. (Payment plans are available. If payment is a barrier, please reach out to nskotz@greatheightsaba.com after submitting this form).

Launch Summer Social Camps Registration Form

Join us for 1, 2, or all 3 sessions!

June 6^th, 2022 — June 17^th, 2022: Social Camp #1
2 weeks; $600
Non-verbal Communication & Conversation Skills

June 20^th, 2022 — July 1^st, 2022: Social Camp #2
2 weeks; $600
First-time camper: Non-verbal Communication & Conversation Skills
Repeat camper: Perspective Taking & Self-Awareness

July 5^th, 2022 — July 22^nd, 2022: Social Camp #3
3 weeks; $700
Job Readiness Camp

Please fill out all fields on this form to register your child.

Child's Information

Parent/Guardian Information

Emergency Contacts

Launch Summer Social Camps Registration Form

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