Intensive Summer Program 
TherapyWorks and Ascent Psychological Services have partnered together to offer the intensive summer service program. We are so excited to be working with your child and your family. Please fill out the registration form attached. Reach out to if you have any questions or concerns. 
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Email *
Child's name *
Child's Date of Birth *
Child's address *
Parent's/Guardian's names *
Parent's/Guardian's Phone numbers  *
Parent's/Guardian's email addresses *
Who else may transport your child?
Please provide their phone numbers. 
Please list child's pertinent medical history.  *
Please list any medications the child takes.  *
Does the child have any allergies (including foods)?  *
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