Square Pegs Learning Center
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  • More
    • Home
    • Contact
    • Student Records & Forms
    • Admissions
    • About Us
    • Our Team
    • Drop off/Pick up
    • Scholarships
    • Programs
    • Community Partners
    • EthicTraining & Reporting
    • Behavior Solutions
Square Pegs Learning Center
  • Home
  • Contact
  • Student Records & Forms
  • Admissions
  • About Us
  • Our Team
  • Drop off/Pick up
  • Scholarships
  • Programs
  • Community Partners
  • EthicTraining & Reporting
  • Behavior Solutions

Please complete the online intake form below. Once administration reviews the form they will reach out within 48 business hours. Thank you for your interest in Square Pegs Learning Center. 

Apply Today

Please email admin@squarepegsconnect.com once you complete
Online Intake Application

Instructions for INTAKE/RELEASE FORMS

How to Complete the Application:

Option 1: Online Application

  • Click the "Online Intake Application" button above.


Required Documents for Enrollment Application:

  • 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
  • Childs IEP and Matrix (from current school district)- these can be brought in to Judith to scan and process)


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

Documents must Attach as PDF:

Save and name the files as follows: {Child's Name} Intake and {Child's Name} Records Request

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 the Forms:

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.

Contact Information:

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.

Square Pegs Learning Center

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