Support Group

Support group is held the second and fourth Wednesday of each month from 6:00 pm until 7:00 pm. We meet in our new office, located at 615 Thain Road Suite A in Lewiston (adjoining Orchard’s Pawn & Tack). Each month, we discuss a different topic centered around autism. Dinner and childcare are provided free of charge to attendees. Parents are encouraged to arrive approximately 15 minutes before the start of group to provide our Child Care Specialists with any special information they may need to know about your child and how their day has been going, so we are all prepared for any issues that might arise. Following group, parents will be given a report on their child’s time in our care.

RSVP is required at least two days in advance of each meeting so we can make the appropriate arrangements for dinner and childcare. However, we understand the difficulties that can arise when planning outings, so we will do our best to accommodate late RSVPs. Our main goal is to have the appropriate staffing to provide extremely low staff to child ratios.

RSVP

All children attending support group with their parent / guardian(s) must have a completed information form on file prior to attendance.

Child’s Legal Name

First Name

Last Name

Child’s Preferred Name

Date of Birth

Enter child’s date of birth

YYYY

Sex

Parent / Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Emergency Contact

First Name

Last Name

Emergency Contact Phone

(###)

###

####

List any physical or developmental disabilities the child has.

Does your child have any allergies?

Yes

If yes, please explain in detail all allergies.

Medical Issues

Please let us know if your child has any other medical issues we need to be aware of.

How does your child prefer to be soothed if they become upset?

Child’s habits, fears, etc.

Does your child have any specific habits or fears we should be aware of?

Additional Information

Please provide us with any additional information we might need to make your child’s experience positive.

Important Information

Child Care Specialists are not allowed to administer medications to children in our care.

If your child becomes upset and we are unable to calm them down, we may need to ask you to step out of the support group meeting and assist us with your child. This will only be done if considered necessary by the Child Care Specialist working with your child.

Please keep us informed of any changes to the information included on this form.

Agreed

Electronic Signature

By entering your name, you attest the information contained above is true and accurate to the best of your knowledge.

First Name

Last Name

Date this form was completed

YYYY