Niagara Sensory Room Booking Form

Niagara Sensory Room Booking Form

Niagara Region Medical Walk-In Clinic, Side Entrance: 8375 Lundy's Ln, Niagara Falls
Step into a calm and welcoming space designed to engage the senses and support relaxation, discovery, and fun. Our Multi-Sensory Experience features soothing lights, textures, sounds, and motion carefully selected to create a rich multi-sensory experience for all ages.

Whether you're a child, youth, or adult you’re welcome to enjoy this safe and inclusive environment. Families, caregivers, and community partners are also invited to bring clients or loved ones for a personalized sensory visit.

Been here before? Come again! We regularly update the room to offer fresh and engaging sensory experiences.

For everyone's comfort and safety, socks are to be worn during your visit.

All available time slots are listed below—register now!
Name of Autistic Participant*

First NameLast Name
Name of Caregiver or Support Staff if Applicable

First NameLast Name
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about the sensory room?*

Autism Ontario Social MediaAutism Ontario NewsletterWord of mouthAutism Ontario EmployeeOther Community AgencyOther

Who will be visiting the sensory room?*

	Enter # of people
Children with autism (17 and younger)
Adults with autism (18 and older)
Caregivers/parents/support workers
Siblings/Friends
Other

Please note that the duration of each appointment is 45 minutes. Example: If your appointment starts at 10:00am, your time slot will end at 10:45am in order to allow time for cleaning prior to the next appointment.
Kindly choose an appointment time from the options below. *
Waivers
It is recommended that participants consult their physician before the start of any physical activity. By registering for or participating in Niagara Sensory Room, participants agree that they are and will be voluntarily participating in this opportunity and assume all risks of injury or death that might result from these activities.*

I agree
I acknowledge and understand that supervision of children/youth/adults is the sole responsibility of parents/guardians and caregivers and release Autism Ontario, its employees, officers, director and agents from all claims arising from any accident, death or injury which is caused by or arises from participation in Niagara Sensory Room. Parents/caregivers must remain present.*

I agree
I understand that appointments are non-transferable and non-refundable.*

I agree
I understand that cancellation is permitted up to 7 days before the appointment.*

I agree
I understand that the sensory room is only for people with an Autism diagnosis and their immediate family members.*

I agree
I hereby waive any claim against Autism Ontario and staff for any personal or emotional distress that may arise in connection with the use of the material(s) and the sensory room.*

I agree
Due to allergies and sensitivities, please refrain from wearing perfume, cologne, aftershave, or scented products such as hairspray or lotion.*

I agree
I understand that socks must be worn at all times while using the Sensory Room*

I agree
If you have any questions or concerns, please don't hesitate to contact us at south@autismontario.com.
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Niagara Sensory Room Booking Form

Waivers