Holiday Break Request
Complete form to let us know which school breaks your student will need services and accommodations during the year. Once all requests are received, we will send details and pricing for each program to the parent email listed below.
Student NAME
*
First Name
Last Name
Student EMAIL
*
example@example.com
Parent NAME
*
First Name
Last Name
Parent EMAIL
*
example@example.com
Name of SCHOOL
*
Enter School Name
Select each break period you want your student to join (check all that apply). Start and end dates may be flexible based on your school's schedule:
*
Fall Long Weekend October 3-8
Fall Long Weekend October 10-14
Fall Long Weekend October 17-21
Thanksgiving Break November 21 - December 1
Winter Break December 17 - January 4
Winter Long Weekend January 29 - February 2
Winter Long Weekend February 5-9
Spring Break March 4-23
Spring Long Weekend April 18-21
Will your student need pickup and drop off at school?
*
YES
NO
What type of activities is your student interested in?
Shopping
Entertainment / Theme Parks
College Tours
Cultural Experiences
Visit Historical Landmarks
Any special needs or requests for your student?
Submit Request
Should be Empty: