Enrol Your Child in NeuPathways Today

Use the form below to make your $150 NeuPathways non-refundable deposit quickly and securely. Your deposit covers your child's pre-assessment in full.

Please note: NeuPathways is a structured, 12-week commitment. Because software licenses and cohort slots are secured in advance, you are committing to the full 12-week tuition. Withdrawals after Week 1 do not exempt the remaining balance.

By submitting this form and deposit, you authorize the pre-assessment and agree to the full 12-week Programme Terms of Payment.

Parent First Name *

Parent Last Name *

Phone *

Email *

Child's Name *

Childs Date of Birth (DD/MM/YYYY) *

Child's Age *

School Year as of September 2026 *

Child's Focus Capability *

--Select-- Focuses well with standard, mild verbal redirection Struggles to focus on digital tasks Requires consistent 1-on-1 adult support

Child's Frustration Response *

--Select-- Quiet withdrawal or seeks reassurance Completely refuses to participate High verbal or physical reactivity

Insurance Provider *

Amount Paid *

Total Amount

$

 

Billing Zipcode*

Credit Card Number*

Expiration Date*

01 02 03 04 05 06 07 08 09 10 11 12 / 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036

Card (CVV) Code*

Card Type*

Visa MasterCard Discover American Express

Card Holder Name*

Verification code*