SOLAR SYSTEM SQUAD REGISTRATION

Saturday Aug 15- Oct 3

2:30-4pm $530

intake@creativetherapyassociates.ca

Child Information

First name

Last name

Date of birth

Address

Parent or Guardian Information

First name

Last name

Home phone number

Cell phone number

Email address

Relationship to child

Medical History

Does the child have any allergies?

Yes No

If yes, please describe:

Is there any relevant medical information or diagnoses that would be helpful for our team to know in order to support your child safely?

Emergency Contact Information

Add another emergency contact

Child Information

Does your child require 1:1 support?

Yes

What strategies or approaches work best to help your child feel comfortable and successful in a group?

Are there any specific triggers, sensitivities, or situations that may cause distress?

How does your child communicate best (e.g., verbal, sign, AAC, gestures)?

What are your child’s favourite activities, hobbies, or interests?

Submitting this registration form is confirmation that you are proceeding with registering your child or youth for Solar System Squad. A consent package will be sent via DocuSign after we receive your completed registration. Enrollment is confirmed once the consent is signed and payment is arranged.

Payment options:
• E-transfer: Mmccallum@creativetherapyassociates.ca
• Credit card: call Marissa Bruce, at 807-624-2590 (Monday–Friday) or via email at intake@creativetherapyassociates.ca

If there is any additional information you would like to share, please email at intake@creativetherapyassociates.ca.

Your information will be encrypted.