All Access Afternoons Registration

All Access Afternoons Registration – Fall 2026

Request your spot for the September–December program, and share support needs so staff can confirm safe placement.
Participant Information
Participant full legal name

First NameMiddle NameLast Name
Name participant prefers to use
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age at program start
Pronouns
Home address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
School currently attending
Parent, Guardian or Primary Contact
Full Name

First NameMiddle NameLast Name
Relationship to Participant
Email Address
example@example.com
Primary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Contact Method
Emergency Contact
Emergency contact name

First NameMiddle NameLast Name
Relationship to participant
Emergency phone number
Please enter a valid phone number.Format: (000) 000-0000.
Authorized to pick up participant?
Registration and Subsidy
Registration option
If applying for a subsidized space, briefly tell us how it would remove a barrier to participation
Acknowledgement
How did you hear about the program?
Previous Inclusions Participation
Has the participant attended any Inclusions programming in the past?
Is all participant information currently on file with Inclusions complete and up to date, including support needs, health information, allergies, medications and emergency information?
I confirm there have been no changes to the participant's support, health, allergy, medication or emergency information since it was last provided to Inclusions.
Participant Support and Accessibility
Optional diagnoses or disabilities you would like staff to know about
How does the participant communicate?

Other
Mobility and physical access needs
Does the participant require 1:1 support to participate safely?
If yes or unsure, please explain
Level of assistance needed for personal care or toileting
Sensory needs, triggers, or environmental considerations
Behaviour or safety concerns staff should plan for

Other safety concern
Helpful calming, regulation, and de-escalation strategies
Road and community safety awareness
Participant's fitness interests, favourite activities, activities they avoid, goals, or hopes for participating in the program
Health, Allergies and Medication
Allergies and dietary restrictions

Other
Medical conditions relevant to physical activity

Other
Activity restrictions or instructions from a healthcare provider
Does the participant carry or require emergency medication during the program?
Medication name
Purpose of the medication
Storage instructions for the medication
Administration instructions for the medication
Medication must arrive in its original pharmacy-labelled container with completed authorization before the participant attends.
Family doctor name

First NameMiddle NameLast Name
Family doctor phone number
Please enter a valid phone number.Format: (000) 000-0000.
Arrival, Departure and Transportation
How does the participant normally arrive?
How does the participant normally leave?
Authorized pickup contacts
Is the participant authorized to leave independently?
Acknowledgement
Consents and Acknowledgements
I confirm the information provided is accurate and I will notify Inclusions of any changes.
I understand registration is subject to staff review and confirmation that the program can safely meet the participant's needs.
I understand this is a group program operating at approximately a 1:4 ratio and is not 1:1 support.
I give permission for emergency first aid and for staff to contact emergency services when necessary.
I understand physical activity carries ordinary risks such as falls, bumps, strains and minor injuries.
I understand payment is due only after placement is confirmed.
Permission for photographs or videos for Inclusions promotional use
Permission for staff to transport the participant in an Inclusions or authorized staff vehicle for scheduled community activities
Final Details and Signature
Additional information staff should know
Typed signature
Name of person completing form

First NameMiddle NameLast Name
Relationship to participant
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

All Access Afternoons Registration – Fall 2026

Participant Information

Parent, Guardian or Primary Contact

Emergency Contact

Registration and Subsidy

Previous Inclusions Participation

Participant Support and Accessibility

Health, Allergies and Medication

Arrival, Departure and Transportation

Consents and Acknowledgements

Final Details and Signature