ACEING AUTISM - MOUNTAIN VIEW, CA (FALL 2020)

MOUNTAIN VIEW, CA
Fall 2020 Session

Sundays
October 11 to November 15
(10/11, 10/18, 10/25, 11/1, 11/8, 11/15)

Children's Program
9:30 am - 10:30 am (5 - 18 yrs)

COVID-19 BEHAVIORAL CONSIDERATIONS
If a participant requires hand-over-hand instructional support, is prone to wandering, running-off, or requires constant supervision of social distancing, the parent/guardian will be expected to come on the court to provide that support to their child.

Please understand that we are not equipped to manage significant behavioral issues.
We will work with you as best we can, but if your child presents any danger to him or herself, other participants, our volunteers and/or our staff, we will need to discontinue your child’s participation in the program, at which point we will immediately reimburse you for the remainder of the session.

Is the participant new to ACEing Autism?

How did you learn about ACEing Autism?

Please elaborate on how you heard about ACEing Autism

Has the participant taken part in ACEing Autism this calendar year?

PARTICIPANT BASICS

Name

Preferred First Name

Date of Birth

Gender

Dominant Hand

Address

City, State and Zip Code

Please provide a current headshot of the participant. This will only be used to identify them upon arrival to clinic and on the courts.

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Participants are expected to wear their ACEing Autism shirt to every clinic.

T-Shirt Size

FAMILY INFORMATION
Parent / Guardian 1

Parent / Guardian Name

Phone Number

Parent / Guardian 2

Parent / Guardian Name

Phone Number

Demographics

What is your estimated annual household income before taxes?