Vacation Services 2018-2019 Form
This form is to indicate your interest for ABACS clinic-based vacation services services. These are drop-off services that we offer and just like services at your home are 1:1 with a BT. They are typically provided between the hours of 9am-3pm, with morning and/or afternoon time slots.

Once the interest form is completed, the process will continue as follows:
1. The Clinic Managers works with scheduling and your child’s BCBA to determine the clinically recommended amount of hours during the vacation.
2. The recommended hours will be reported to you, at which point you can discuss availability during those dates and times.
3. Once your requested times and dates for services are received, staffing will be confirmed through closer to the start of services.

Form Completion
Please fill out the following form to indicate the days you are interested in vacation services.
Client's name *
Your answer
Your name *
Your answer
Email address *
Your answer
Please select your preferred location for services. *
What session time(s) would you like your child to attend services? *
Please indicate the vacation days/weeks you are interested in having your child attend services. (Please note the deadlines on the website for all vacation services.) *
Please note anything else you would like us to know or consider during this process (e.g., dates outside of those listed above, questions, allergies, etc.) (optional):
Your answer
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