Family Registration form
Thank you so much for choosing Maxwell's House of Abilities.  
Please fill out the form below and attach all documents i.e. IEP, Diagnosis, etc. for your child.
Registration fee varies depending on the type of service.  
Please feel to call the Director Christina Shelley at 832-447-7576    
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Email *
Childs Name *
First and last name
Childs  Date of birth *
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Gender *
Grade level *
Childs diagnosis *
Required
Please provide us with any important personality details about your child. *
Please check all the services of interest for you child/adult. *
Required
Allergies *
Pediatricians name and Contact information   *
Parents Name *
Phone Number *
Address *
Emergency contacts and Authorized Pickups *
Late,  Late Notices or No Call No Show Fees:               Late pick ups equation $10 ( for 1st 5 mins) + ($1 every 2 mins after that)                                                                  Late Notice: less than 2 hour notice your child will not be coming full session rate or hourly rate will be charged  this is for non students                                        No Call No show full your Childs full rate will be charged for that session .   *
Date of submission *
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