Intent to Register

Please note that this form is only for students that have been accepted to REConnections Education Center.

Caregiver Name*
First Last
Caregiver Email Address*
Caregiver Phone Number*
Child's Name*
First Last
Child's Age*
Grade of Child for the School Year enrolling in*
Please enter a number from 0 to 22.
Diagnosis of Child if known
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Schedule a Tour

We are currently scheduling tours for the upcoming school year.

2107 Gunn Highway
Suite 106
Odessa, FL 33556