Kids & Teens Involvement Form
Parents fill in the form below to have your child participate in our sensory fashion workshop programs and fashion show. Must live in the Southern California area to be selected.
Parent Name
*
First Name
Last Name
Parent Name
First Name
Last Name
Parent Phone Number
*
Alternate phone number
Parent E-mail
*
(Please list parent email who will be in contact with us the most)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
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Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
How did you hear about us?
*
Child Name
*
First Name
Last Name
Child Birthday
*
-
Month
-
Day
Year
Date
Child Age
*
Gender:
*
Please Select
Male
Female
Prefer not to say
Other
Please list your child’s clothing sizes IE: Shirt, Pants, Shoes, Dress ect:
*
Do you understand that when applying, you agree to commit to multiple dates (TBD) for our 2023 sensory summer workshops and fashion show?
*
Please find below the scheduled dates for the workshops and fashion show. Kindly note that these dates may subject to change.
August 5th, Meet & Greet Workshop
August 6th, Model Coaching Worksop
August 7th, Photoshoot Workshop
September 2nd, Fashion Show
Has your child been diagnosed on the Autism Spectrum or related? Please explain. IE: Full diagnosis, high-low functioning, therapy, when diagnosed, ect.
*
Please select all boxes that apply to your child:
*
Prone to wondering
A picky eater
Needs frequent breaks
Needs constant reminders
Has a curious mentality
Do you feel comfortable having the staff come to your home to get to know you and your child?
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List your child’s favorite activities:
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List all behaviors:
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List all sensory sensivities:
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What does your child prefer to play with?
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What therapy has made the most difference?
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Does your child have trouble participating in groups? Does your child have trouble following cooperative rules for games and activities? If so, please explain.
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Does your child take any medications? If so, would they need to be administered during our workshops?
*
Please list allergies and any other health concerns:
*
In case of an emergency, what hospital would you prefer?
*
Upload a current photo:
*
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