Enrollment request form

Steps:

1) Complete form (HIPAA compliant)

2) complete DocuSign (consent forms)

3) Download our communications app

Questions? call us (352)437-3559

First name

Last name

Childs full name

Email address

Phone number

ABA referral

CDE (testing documents)

IEP

Insurance card

Guardian ID

Birthday of child you're attempting to enroll

Month

Day

Year

What program are you interested in ?

Luminary Academy ( hours 8 AM -2 PM, Monday-Friday)

Dade City Location- ABA Therapy In Center ( hours 8 AM -2 PM, Monday-Friday)

Brooksville Location-ABA Therapy In Center ( hours 8 AM -2 PM, Monday-Friday)

Parrish/Bradenton/Sarasota- In School/ Daycare/ Community ABA Therapy

Tampa- In School/ Daycare /Community ABA Therapy

Opening Hours

Mon - Fri

8am-2pm

Welcome to the Lumi community