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MMTA Get-To-Know-You Registration Form 2025
This event is designed for neurodiverse individuals of all communication levels.  If the individual requires 1:1 support at school or in the community, please be prepared to send someone with the individual.  

Note: This event is capped at 25 participants on a first-come-first-served basis
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Email *
Participant's Name *
Participant's Age as of February 28, 2025 *
Participant's Diagnoses  *
Form completed by (name and relationship to group participant) *
Phone number of person completing the form *
Date Form Completed *
Parent/Guardian #1's Information: name, phone number, and email *
Parent/Guardian #2's information (if applicable): name, phone number, and email *
Parent/Guardian # 3's information (if applicable): name, phone number, and email *
Home Address *
Emergency Contact (in the event that we could not reach you:  name, relationship, phone number) *
Group participant's school, work, or other current programming:
District:
Grade:
Classroom type/s:
Other: 
 *
Current Therapies (speech, occupational therapy, physical therapy, other)  *
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