Trailblazers Club Registration Form

The Trailblazers Club Spring 2026: Registration Form

Thank you for your interest in our program! We know there are quite a few questions, but each one is important. Please reach out if you need any help. If you prefer a printed version or a pdf version, we’d be happy to provide one.
Today's Date

MonthDayYear
Date
Trailblazer Information
Full Name*
Are you already a registered Trailblazer member?*
If you have completed a registration form for: 1:1 Services, The Trailblazers Club or The Adventure Club, please select 'YES'.
Date of Birth*

MonthDayYear
Date
Phone Number*
Format: (000) 000-0000.
Email Address (if primary contact)*
HSRDARTSSupport Worker / GuardianOther
SmallMediumLargeX-Large2XOther
Primary Contact

This is the person we will contact for program updates, scheduling changes, emergencies and important information.
Contact Name*
We primarily communicate via email, unless otherwise specified or in the case of an emergency.
Contact Phone Number
Format: (000) 000-0000.
Contact Email*
Relationship to Trailblazer
Medical
Has your medical situation or medical protocols changed?*
If you wish to update your medical info already on file, please click 'yes' and enter the info into the box provided.
Please list any medical conditions, allergies, or food restrictions that we should be aware of.If there are any safety-related medical considerations (for example, seizure protocols), please include them here.You may also share any medical or developmental diagnoses that would help us plan safe and inclusive programming.*
Do you carry an Epipen?*
Accommodations & Supports
Has your accommodations, supports or behaviour support plan changed?*
If you wish to update your behavioral, accommodations or supports info already on file, please click 'yes' and enter the info into the box provided.
What accommodations or supports can we provide to help you participate comfortably?If you have a Behaviour Support Plan, please email it to Pathfinder@uniqueoptimism.ca .Please include any relevant diagnoses or information that would help us understand how to best support you during Club activities.The more detail you can share, the better we can make your experience!*
I consent to participate in activities organized by Unique Optimism and understand that additional consent forms may be required for specific activities or situations.
Behaviour Guidelines & Expectation
1. The Trailblazers Club is designed to be a welcoming and inclusive space where everyone can feel safe and enjoy the experience.
2. Trailblazers and their supports (if applicable) are expected to interact respectfully and help maintain a positive group environment.
3. Please note that the Trailblazers Club is a group-based program and consistent 1:1 support is not provided. Trailblazers who require ongoing 1:1 support are expected to attend with their guardian or support worker, who can assist with redirection if needed.
4. If behaviours significantly impact the safety or experience of others, participation may need to be revisited. Unique Optimism reserves the right to withdraw a participant if group safety or dynamics are at risk. No refunds will be issued in these cases.
I have read and agree to the Trailblazers Club behaviour expectations and understand that failure to follow these guidelines may result in removal from the program without a refund..
Service Dog in Training Acknowledgement
Rufus, a service dog in training with Autism Dog Services, may join us during some Trailblazers Club sessions as part of his training and socialization. Interactions with Rufus will always be supervised by a Pathfinder, and Trailblazers will be guided on how to respectfully interact with him when appropriate.
I understand that a service dog in training may be present during Trailblazers Club activities.
Funding
Directly to me (Trailblazer or Primary Contact)To my Passport One funding contact (provide details)
📩 If Passport One or Other, please provide the contact name & email:
I consent to Unique Optimism contacting my Passport One worker or other funding contacts.
Securing Your Spot
1. Spots in the Trailblazers Club are limited and there is often a waitlist.
2. After submitting the registration form, an invoice will be sent. Payment must be received within 14 days to secure your Trailblazer’s spot.
3. If payment is not received by the due date, the spot will be released and offered to the next Trailblazer on the waitlist.
I understand that payment must be received within 14 days to secure my Trailblazer’s spot.
Special Activity Acknowledgement
1. One Trailblazers Club session will take place off site at Splitsville Bowling on May 20, 2026, unless otherwise communicated in advance. On this date the program will take place exclusively at Splitsville.
2. Bowling lanes are booked and prepaid in advance, therefore refunds or credits cannot be provided if a Trailblazer is unable to attend this session.
3. Trailblazers and their guardians/supports are responsible for their own transportation and must meet the Pathfinders directly at Splitsville.
I understand and acknowledge the Splitsville Bowling session details, including the off site location, transportation responsibility, and the prepaid nature of this activity.
Refund & Withdrawal Policy
1. Full payment is required by the due date on your invoice to secure your Trailblazer’s spot. If payment is not received by this date, the spot will be released to the waitlist.
2. Withdrawals made more than 30 days before the program start date will receive a full refund minus a $35 administration fee.
3. Withdrawals made within 30 days of the program start date are non-refundable, as staffing, materials, and venue bookings are arranged in advance.
4. Refunds or credits cannot be provided for missed sessions or unattended activities, including sessions where venues or materials have been prepaid.
5. If the full program must be cancelled due to circumstances beyond our control, a partial refund (minus prepaid expenses and the $35 administration fee) will be provided.
I have read and agree to the refund & withdrawal policy.
Program Information Acknowledgement
I confirm that I have reviewed the Trailblazers Club information and FAQ on the Unique Optimism website.
Consents & Permissions
I understand and consent to the collection and use of the information provided in this intake form for support purposes, and acknowledge the confidentiality policies as described.
I understand that all personal information collected will be kept confidential and shared only with authorized personnel as required by law.
YesNo
Yes, I consent to being photographed or filmed during my participation in activities for promotional and documentation purposes by Unique Optimism, including use on social media, websites, or other digital and printed materials.I do not consent to being photographed or filmed for promotional or documentation purposes.
Yes, I consent to receiving emails related to support, programs, updates, newsletters, or promotional materials from Unique Optimism.No, I do not consent to receiving emails.
Liability Waiver & Consent
I, the undersigned, as the primary contact/legal guardian, acknowledge and accept the risks associated with participation in this program. I consent to the Trailblazer taking part in the activities outlined, and I agree to release Unique Optimism and its employees, volunteers, and affiliates from any liability related to injury, loss, or damage arising from the participation in these activities.
Primary Contact Signature*
Date*

MonthDayYear
Date
Thank you!

We appreciate you taking the time to complete your registration. Once received, we’ll contact you to confirm your spot (or let you know if a waitlist is in place).

*IMPORTANT* Don’t forget to add pathfinder@uniqueoptimism.ca
to your address book so you don’t miss any updates. All correspondence from us is done via email, unless it is an emergency. So, it is important to mark our email address as 'not junk/spam' to ensure our emails don't detour to your junk or spam folders.

Please don’t hesitate to reach out with any questions. Stay snazzy!
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The Trailblazers Club Spring 2026: Registration Form

Trailblazer Information

Primary Contact

Medical

Accommodations & Supports

Behaviour Guidelines & Expectation

Service Dog in Training Acknowledgement

Funding

Securing Your Spot

Special Activity Acknowledgement

Refund & Withdrawal Policy

Program Information Acknowledgement

Consents & Permissions

Liability Waiver & Consent