Join our fun experience!

Welcome to our after school haven for autistic children. Embrace the joy of sensory play and sports activities with us!

Child's Name

First Name

Last Name

Parent's Email

Subject

Message

Child's Date of Birth

YYYY

Parent/ Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Details of General Practitioner

Name, Address, Contact number

What Days & Time are you signing up for

If your child suffers from any illness, disability or allergy, please list below

Tell me as much information as possible about your child. The more information the better!

Interests, Triggers, Preferred method of communication, etc

Preferred method of payment- Payment is required weekly in advance of the following week

Bank Transfer, Revolut, Paypal, Cash

Do you consent to having your child photographed for marketing purposes and for sharing memories with parents

Yes or No