RSVP 1 — Outside the Box Therapy

Register

Complete the form below to register for 2023 programs and events.

Child's Name

First Name

Last Name

Parent/Guardian Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Program

Child's Age and Grade

Why do you want your child to attend this program?

Please check all that apply:

Uses a mobility device

Uses an AAC device

Requires an ASL interpreter

Has allergies (please list below)

List allergies here

How did you hear about Outside the Box Therapy?

I would like to be contacted to see if my family qualifies for a discounted/waived fee:

Please share any additional information you would like us to know about your child, or any questions you may have. We will contact you ASAP to answer any questions.

After registering, you will be redirected to pay the program fee via PayPal. Registration is not complete until program fees are paid. (If you select the box to be contacted about discounted rates, we will reach out with more information and instructions.)