ErinoakKids - Autism ABA Winter Registration

Have you received services at ErinoakKids before?

Yes No

What is your preferred site to receive ABA Services? (select all that apply)

Halton (Oakville) Mississauga Brampton

What is your preferred schedule for receiving ABA Services? (select all that apply)

Mornings (9 am to 12 pm) Afternoons (1 pm to 4 pm)

What is your preferred frequency per week of ABA Services? (select all that apply)

Two (2) ABA half-day sessions per week (Tuesday/Thursday) Three (3) ABA half-day sessions per week (Monday/Wednesday/Friday)

Registration Acknowledgement

I understand that submission of this form does not guarantee an available spot; only that I will be contacted by ErinoakKids to determine next steps. I understand that the Terms of Engagement must be signed and payment collected once I am contacted by ErinoakKids to finalize registration.

1:1 Service Acknowledgement

I understand this service includes 1:1 support with a Behaviour Clinician and is not appropriate or applicable for children requiring more support.

Consent to Contact

This information is being submitted with the knowledge and consent of the parents/legal guardians. By providing the contact information within the form, you consent to being contacted by ErinoakKids. ErinoakKids will always treat your personal details with the utmost care and will not share or sell your personal information. We are committed to keeping your information safe and confidential. We follow the rules set out in law about collecting, using, and disclosing your personal information. For more information, please review our privacy policies publicly posted at https://www.erinoakkids.ca/privacy.

Please Confirm