Group Registration Has this participant attended Social Thinking Groups (or had a group intake) at TAFA in the past? *YesNoIntake Acknowledgement *I acknowledge that Participants will be placed into groups based on factors such as age and social thinking skills. New participants must complete a brief in-person intake (15–20 minutes) with our trained staff before joining a group. The first step in this process is an initial intake fee of $25.00.Is the participant 18 years of age or older? *YesNoParticipant First Name *Participant Last Name *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeParticipant Email AddressParticipant Date of Birth *Gender *MaleFemaleNon-BinaryTell us about your childSchool *Grade *Does the participant have allergies/food restrictions? *YesNoPlease list all known allergies/food restrictions:What are some of your child's favorite activities? *Does your child have difficulty with sensations - touch, light, noise, movement? *Does your child's activity level or temperament interfere with daily activities? *How would you describe your child's communication skills? *Does your child have any physical limitations? *Does your child experience and separation difficulties?Will your child stay with a group? *Please describe strategies that you find effective in supporting positive behaviors with your child: *Is there anything else you would like us to know about your child? *Tell us about yourselfTell us about yourselfI'm a studentI'm currently workingI hold a driver's licenseI live at homeI live alone/with roomateI have my own vehicleWhat are some of your hobbies? *Do you have difficulty with sensations - touch, light, noise, movement? *Does your activity level or temperament interfere with daily activities? *How would you describe your communications skills? *Do you have any physical limitations? *Do you experience difficulty being in a room with people you don't know? *Do you have any food allergies or restrictions? *Is there anything else you would like us to know about you?How did you hear about TAFA? *Friend/FamilyMedical Provider/CaseworkerSocial MediaGoogleOtherIs there any new information you'd like to share with us since the last session was attended?Parent/Guardian InformationParent/Guardian First NameParent/Guardian Last NameParent/Guardian Mobile PhoneParent/Guardian Email Address*OPTIONAL Parent/Guardian Name*OPTIONAL Parent /Guardian Phone*OPTIONAL Parent/Guardian Email AddressFees$Optional Scholarship DonationWould you consider adding a donation to the TAFA Scholarship Fund to help ensure every family can access evaluations, social groups, and support—regardless of financial barriers?USDTotalCredit / Debit Card *Consent *By submitting this form I understand that: No client will be placed in a group without registration and registration payment prior to the start of group. Payments are due in full before the start of each session. If we do not have a minimum of three students per group, the group may be cancelled and any fees paid will be refunded. TAFA is an out of network provider and does not submit insurance claims. We do accept ESA and HSA. For safety, parents must remain on premises during group. Students are placed in groups depending on age and level of perspective taking ability. In some cases, a student may not be ready for group. Students will be assessed by the instructors and additional recommendations will be made to prepare the student for future groups participation. Signature *Start signing your signature hereYour browser does not support e-Signature field.Submit
