Child Application Form

Thank you for visiting us and applying for a placement under our new Model.

We are the only ABA bespoke parent and child training scheme that support and teach parents by having one parent actually working hands on 1:1 with their child in session rather than a volunteer - allowing the parent to learn how to work on targets at home.

We love our new model where we empower, support and invest the training in parents.

Your Name(*)

Please let us know your name.

Phone Number(*)

Invalid Input

Your Email Address(*)

Please let us know your email address.

Your Address(*)

Invalid Input

Area

Invalid Input

Town/City(*)

Invalid Input

County(*)

Invalid Input

Post Code(*)

Invalid Input

Please tell us a little about your child.

Would you like us to put your child's name down for the next available intake? There are only 24 places available for each intake, if there are no spaces left we will put you on the future intake waiting list.(*)

YesNo

Invalid Input

Childs Name(*)

Invalid Input

Gender(*)

Invalid Input

Childs Age(*)

Invalid Input

Date of Birth

Invalid Input

Has your child had ABA before?(*)

YesNo

Invalid Input

If 'Yes' how long?

Invalid Input

Under which consultancy?

Invalid Input

The Club is located in Bolton and starts at 10am (arriving at 9.45am for registration) every Saturday for a 10 week period. The cost for the March intake for you and your child (which includes your child's assessment, target write ups and implementation, your child's exit report plus your training at Saturday school plus the 2 day initial parent training) will be £360. The course require 1 parent to work with their child every week - the parent will tutor the child under guidance from supervisors and room leaders.

Do you agree to pay the fee of £360(*)

YesNo

Invalid Input

Please can you name the parent (by name and if mother or father) that will be attending the training and working one to one with their child each week(*)

Invalid Input

The course is a 10 week course plus 2 extra training days, by accepting a placement you are agreeing to attend the full course please tick that you agree(*)

YesNo

Invalid Input

Would you be able to help in any of the following ways? Please tick those you can help out with.

If you answered 'Other' above please leave details.

Invalid Input

Your Child will be assessed before starting Saturday Club A questionnaire and/or paperwork must be filled in prior to the assessment date which is accessed via the website We can not assess a child without this paperwork do you agree to fill this in within the time frame given in the email?(*)

YesNo

Invalid Input

If you have any questions please use the box below

Invalid Input

How Did You Hear About ASUK?(*)

Invalid Input

Please Tick(*)

Invalid Input

Today	27
This Week	522
This Month	522
All Time	235240