Apply Today

Option 1: Online Application

• Click the "Online Intake Application" button above.

Option 2: Download and Complete the Forms

• SPLC-SPBS Intake and Medical-Educational Release.
• Please download and complete these forms using Adobe.

• Immunization Records
• Child’s Social Security Card
• Birth Certificate
• Current Physical (If unavailable, it must be uploaded within 30 days of acceptance.)
• Child’s Insurance Card (Required for ABA services)
• Parent/Guardian's Driver's License

(All documents are required to be uploaded at the time of completing application process)

 We prefer electronic submission to ensure that the information remains legible and easy to read. If you are unable to fill out the forms using Adobe and need to print them, please ensure they are legible and return them to us in PDF format, not as a picture.

Save and name the files as follows: {Child's Name} Intake and {Child's Name} Release.

Please attach the completed forms as PDF files.

Do not send pictures or screenshots, as they are often too dark and difficult to read.

Submitting Your Application:

Once you have completed the online application, please send an email to admin@squarepegsconnect.com, including your child's name in the subject line.

Submitting Downloaded Forms:

After completing the downloaded forms, please email them to admin@squarepegsconnect.com.

If you have any questions or need assistance with the forms, please reach out to Judith at Square Pegs Admissions by calling 850-270-8411.