(OH) Cincinnati - 2023 Cincinnati Open Clinic

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Cincinnati, OH: 2023 Cincinnati Open Clinic
Sunday: August 20th, 2023

11:30 am - 12:20 pm (5 - 10 yrs)

12:30 - 1:20 pm (11 - 15 yrs)

1:30 - 2:20 pm (16 - 18+ yrs)

*Once you have arrived at the facility, it will take you time to get to the courts. Please try to arrive 30 minutes early.*

(OH) Cincinnati - 2023 Cincinnati Open Clinic*

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2023/08/20*

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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

Date of Birth*

Gender*

Dominant Hand*

Country*

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*

How many people in your family will be attending the clinic? (we will need to provide each person with a ticket to the grounds):*

Names of Guests Attending:*

FAMILY INFORMATION
Parent / Guardian 1

Parent / Guardian Name*

Email*

Phone Number*

Parent / Guardian 2

Parent / Guardian Name

Phone Number

Demographics

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

What is your estimated annual household income before taxes?*