Do you currently receive ABA Services from ABA Connection?
Dietary Need/ Food Allergies
Other Concerns (ex: behavioral, peer interactions, toileting) *
How many hours are you interested in per week? *
Are there any consistent days the client will NOT be attending? *
How did you hear about us? If referred by an ABA Connection employee, please write their name here. *
Permission to Photograph Photographs taken while at camp may be used used in social media posts or in printed publications. *
Permission to Treat
The Person this registration is for has permission to engage in all camp activities except as noted. I hereby give my permission to ABA Connection to provide routine first aid/health care, oversee self-administration of any medications provided by caregiver, and seek emergency medical treatment. I agree to the release of any records necessary for insurance purposes if receiving ABA Therapy. In the event that I or the emergency contact cannot be reached in an emergency I hereby give permission to ABA Connection to secure and administer treatment, including hospitalization, for the person named in this form. This completed registration form may be printed/copied as needed.
Type your full name below to confirm your acceptance of the above Authorization and Acknowledgements statement *
Camp Fees are $175/week which covers 40 hours per week of camp attendance. Camp fees are non-refundable and are due at least 1 week in advance. Camp fees will cover arts & crafts, trained behavioral staff, and additional materials/activities.
Camp Fees may be paid electronically through PayPal. Payment plans are available.
Pay via PayPal
For More Information
Contact the ABA Connection Office at
Phone: (904) 201-9129
Address: 175 Cumberland Park Dr, Ste 100, St. Augustine, FL 32095