(CA) Cerritos - Spring 2025

CERRITOS, CA
Spring 2025 Session

Saturdays
February 22 to March 29
(2/22, 3/1, 3/8, 3/15, 3/22, 3/29)

Clinic Times:
12:25 - 1:25 pm (5 - 18 yrs)

(CA) Cerritos*

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2024/02/22*

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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

Pronouns

Date of Birth*

Gender*

Dominant Hand*

Address*

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*

Email*

Phone Number*

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Parent / Guardian 2

Parent / Guardian Name

Phone Number

Demographics

What is the participant's ethnicity / race? (Check all that apply)*

Black or African American
Caucasian or White
Hispanic or Latino
Native American
Native Hawaiian or other Pacific Islander
Asian
Other
Prefer not to answer

What is your estimated annual household income before taxes?*

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