• Tween/Teen Group Registration Form

    Thank you for your interest in our tween/teen summer program. Please complete this form to help us determine fit, support needs, and programming considerations for your child. Submission of this form does not guarantee placement. Families will be contacted to confirm registration, availability, and any additional support requirements.
  • Which week(s) are you registering for?*

  • Youth Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Communication and Independence

  • How does your child typically communicate?*
  • How independent is your child in a small-group community setting?*

  • Funding and Current Supports

  • Will this program be paid privately or through Autism Funding?*
  • Does your child currently receive any of the following supports?*

  • Interests and Group Fit

  • What kinds of activities does your child especially enjoy?*
  • How does your child typically do in a small-group setting?*

  • Regulation, Behaviour, and Safety

  • Does your child ever engage in any of the following when upset, overwhelmed, or dysregulated?*
  • Are there any safety concerns we should be aware of during community outings?*
  • What are your main goals for your child in attending this program?*
  • Consent acknowledgements*
  • Date*
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  • Should be Empty: