Application Form
Apply For Placement
Join Our School Family
Applying for preschool and therapy placement at Carolina Therapeutics Academy is easy and secure. Simply complete our online form in ProCare, our childcare management platform. From there, we will verify your insurance coverage, secure all necessary documentation, and schedule an evaluation with our clinical team.
Application Form
Most of the information you will need to complete for either CTA enrollment or After-School Therapy placement is likely close at hand, but some sections may require that you gather details in advance. You will need to provide information about your child(ren) and the adults responsible for your child, and agree to adhere with our policies and procedures.
STUDENT INFO
- General Information & Profile Photo
- Therapy History
- Medical history
- Considerations & Concerns
- Referring Physician
CAREGIVER INFO
- Parent/Caregiver Information
- Emergency Contact information
- Primary Insurance
- Secondary Insurance, if applicable
- Authorized Pick Up Persons
POLICY & WAIVER
- Consent to Treat
- Financial Authorization for Therapy
- Rights, Responsibilities & Code of Conduct
- Tuition & Late Fees
- Wellness Policy
Schedule A Tour
We would love to meet your family, give you a tour of our school, and tell you all about our exceptional children’s program before you apply. Connect with us to schedule an appointment!
