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Please Complete This Form To Continue on to Your Booking

Patients MUST be under the age of 16 years old. Patients MUST have an official diagnosis of HIE, CP, TBI, or NFD. Other diagnosis will be considered on a case by case basis.

Travel cost are a separate fee. Travel costs will be determined after an intensive is fully booked. The costs of travel will be divided equally 4 ways and charged to each family accordingly.

NJPFA reserves the right to cancel any intensive due to lack of participation.  In the unlikely event NJPFA cancels the intensive for any reason, a full refund will be provided.

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