Child Participation Form LA

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 NameLast Name
Parent Name

First NameLast 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

CityState / Province

Postal / Zip CodeCountry
How did you hear about us?*
Child Name*

First NameLast Name
Child Birthday *

MonthDayYear
Date
Child Age *
Gender:*
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 WorkshopAugust 6th, Model Coaching WorksopAugust 7th, Photoshoot WorkshopSeptember 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 wonderingA picky eaterNeeds frequent breaksNeeds constant remindersHas a curious mentality
Do you feel comfortable having the staff come to your home to get to know you and your child?*
List your child’s favorite activities:*
List all behaviors:*
List all sensory sensivities:*
What does your child prefer to play with?*
What therapy has made the most difference? *
Does your child have trouble participating in groups? Does your child have trouble following cooperative rules for games and activities? If so, please explain.*
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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Kids & Teens Involvement Form