Client Application

Complete the secure online form or download the fillable PDF to complete, save and print.

Download fillable applicationType into the PDF, save it and print a copy

Secure online applicationSubmitted information is stored in a private dashboard

1 Participant details

Legal name *Preferred nameDate of birthProgram interest *Primary contact name *Relationship to participantContact email *Contact phone *

2 Support information

Funding sourceEmergency contact and phoneCommunication style, AAC or visual supportsHealth, allergies, seizure or safety informationMedications and assistance needed during program hoursStrengths, goals, interests and preferred activities *Anything else we should know

1 Participant details

2 Support information

3 Consent and submission