Summer Group Program - Expression of Interest Form
  • Summer Day Program for Autistic Youth and Young Adults - Expression of Interest

    Hosted by Julia Ryan Psychology

     

  • Welcome! Thank you for your interest in our summer program for autistic youth.

    This form provides key information for you about the program, and allows us to collect some information about the person who would join our group. 

    After completing the form, our program coordinator and supervisor will review the request and subsequently reach out to you to schedule an introductory call to discuss the participant's suitability for the program and answer any questions you have.

    Following this, we require an in person intake with our coordinator at a fee of $150 which is separate from the program fees.

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  • Format: (000) 000-0000.
  • I am filling this out for:*
  • Format: (000) 000-0000.
  • Consent from both legal custodians is required if separated or divorced

    By law, we require consent from all parent(s) and/or legal guardian(s) who hold legal custody and medical decision-making authority before services can begin. Mutual consent is assumed for parents who are married and living together.

    In situations where parents or legal guardians are separated or divorced, it is clinic policy to obtain consent from all individuals with legal decision-making rights and to include them in relevant communication related to intake and services. As part of this process, we will request contact information for the second caregiver so that they can be provided with consent forms and an opportunity to share relevant information.

    While not all parents choose to actively participate in services, consent and inclusion at the intake stage are required to ensure ethical practice, informed decision-making, and compliance with professional and legal standards.

     

  • Do you have sole legal custody of the Client or do you share joint legal custody with another person? (Married or separated parents are usually joint custodians)*
  • What is your current relationship status with the Client's other legal custodian (the person you share joint legal custody with)?*
  • Format: (000) 000-0000.
  • How did you hear about our services?
  • Information about the Program

  • Nature of the Service
    This service is a structured psychological group intervention.

    The program combines:

    • Experiential activities
    • Social interaction
    • Guided discussion
    • Skill-building opportunities

    The goal is to support confidence, social connection, emotional wellbeing, and personal growth in a supportive peer environment. Goals of service include:

    • Providing a supportive, welcoming, and inclusive space for youth
    • Supporting youth in building confidence and self-expression
    • Helping youth develop peer connections and a sense of community
    • Offering activity-based experiential learning opportunities
    • Encouraging growth in communication, coping, and self-advocacy

    While this group includes recreational and experiential activities, it is not a substitute for individual psychotherapy, medical care, or crisis services.

    Program Structure

    Dates: July 14th – August 20th
    Days: Tuesdays, Wednesdays, and Thursdays

    Time Options:

    9:00am–12:00pm 
    1:00pm–4:00pm 
    Groups are generally organized by age, with flexibility depending on individual needs. Our program coordinator and supervisor arrange groupings.

     

    Risks and Benefits of Participation
    Participating in a group program can offer many benefits but may also involve certain risks.

    Potential Benefits
    Participants may experience:

    • Increased confidence and social comfort
    • Opportunities to connect with peers
    • A stronger sense of belonging and community
    • Development of coping, communication, and self-advocacy skills
    • Positive shared experiences and memories

    Potential Risks
    Participating in a group may involve:

    • Feeling uncomfortable discussing personal topics
    • Emotional reactions when hearing others’ experiences
    • Occasional misunderstandings or disagreements between participants
    • Anxiety related to social situations or new experiences

    While facilitators actively support respectful interactions, some level of discomfort can occur as part of the learning and growth process.

    Participants may also find that the group does not meet their needs or expectations. Benefits vary for each individual.

    Facilitators

    Our groups are led by experienced facilitators from the Julia Ryan Psychology practice.

    All programming operates under the clinical direction and supervision of Dr. Julia Ryan, Ph.D., C. Psych (CPBAO #6871)

    Our practice is regulated by the College of Psychologists and Behaviour Analysts of Ontario, which ensures that services are provided safely, ethically, and competently.

    More information can be found at:
    https://cpbao.on.ca/

  • Information about the Program

  • Group Expectations
    We aim to create a safe, supportive, and inclusive environment where all participants feel comfortable being themselves and learning together. Social situations can sometimes be challenging, and the group is a space where youth can practice communication, collaboration, and self-advocacy with support from facilitators.

    Participants are encouraged to:

    • Treat others with kindness and respect
    • Be mindful of others’ feelings and perspectives
    • Follow facilitator guidance during activities
    • Respect the privacy of other participants and what is shared in the group

    Facilitators recognize that youth may have different communication styles, sensory needs, and ways of interacting, and we work with participants to support positive interactions and problem-solve challenges when they arise.

    If behaviours significantly impact the safety or participation of others, facilitators will work with the youth and family to determine whether additional supports are needed or whether the group remains the best fit at that time.

  • Attendance and Commitment

    This program is a closed group, meaning the same participants attend each session throughout the program. This helps youth become familiar with one another and build a sense of comfort, trust, and connection over time.

    Regular attendance helps support this process. At the same time, we understand that participation can sometimes feel challenging, particularly for youth who may experience anxiety, sensory overwhelm, fatigue, or unexpected life events. Our team is here to help support participation, so we will work closely with you to promote attendance.

     

    Because group spaces are limited and reserved for each participant, missed sessions cannot be refunded or rescheduled.

  • Community Outings
    To support the program goals, the group may participate in community outings that support learning, connection, and positive experiences.

    Examples may include:

    • restaurants or stores
    • visiting farms, markets, animal recues, community events
    • outdoor activities like park or beach
    • fruit or vegetable picking,
    • escape rooms or similar group activities

    Benefits of Outings
    These experiences allow youth to practice communication, coping, and life skills in real-world settings and strengthen relationships with peers.

    Potential Risks
    Community outings may involve risks such as:

    • travel delays or accidents
    • outdoor hazards (tripping, weather, illness)
    • sensory overload from crowds or noise

    Facilitators take reasonable precautions to minimize risks and support youth with successful participation.


    Transportation
    Depending on the outing, transportation may occur by:

    • public transit
    • rideshare services
    • staff vehicles

    When staff vehicles are used, drivers will have:

    • valid driver’s licenses
    • current insurance
    • registered vehicles

    Parents will receive advance notice of planned outings including exact location details, timing of the outing and contact information for facilitators attending the outing.

  • Information about the Program

  • Service Fees

    The cost of the youth group is:
    $200/day
    $3,600 for the six-week program

    Payment schedule:

    $1200 deposit to secure spot; due by June 1st

    The remaining balance is due in full by July 14 (first day of the program).

    Fees may be paid by:

    • Credit card
    • E-transfer

    Payment must be received prior to participation. A credit card will be required required for all files.


    Insurance
    Receipts will be issued as a Group Psychological Service under Dr. Julia Ryan, C. Psych.

    Many extended health benefit plans provide coverage for psychological services. Please confirm details with your insurer. 

    We provide direct billing to many companies to support families with their claims, though in most cases there are still some remaining fees to cover via credit card or e-transfer. 

    Families are responsible for confirming eligibility and submitting claims when required.


    Refund Policy
    Because this is a closed group program with limited spaces:

    • Missed sessions cannot be refunded
    • Late cancellations cannot be credited or rescheduled

    Withdrawal from Service

    You have the right to withdraw your consent for the service at any time, without penalty.

    The deposit is non-refundable and if you decide to withdraw your child from services, you will still be charged, and required to settle, fees for work completed prior to your decision to withdraw.

  • Tell us about you/your child

    The following questions help us learn a bit about your child. After completing this form, our program coordinator, Christina Quaile, will reach out to further discuss this program with you to determine if it is a good fit for their needs.
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