Kickin' It Coalition Spring 2025 Registration (12:00-1:00PM Clinics)

A parent or guardian must be present at each clinic. There will be four clinics this Fall: September 28th, October 5th, October 19th, and October 26th. In the event of inclement weather, we may need to cancel a clinic, and you will be notified in advance.

After we finalize the participant list, you’ll receive a follow-up email with an overview of the clinic format, what to bring, directions to the field/parking, and other additional information.

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Email *
How did you find out about Kickin' It Coalition *
Participant's Name *
Participant's Age
 *
Participant's Diagnosis/Diagnoses
 *
Participant's Allergies *
Caregiver Name *
Caregiver Cellphone *
Does the participant use verbal language to communicate? *
Does the participant have any triggers that would be helpful for us to know about? What works best to calm them down if they become upset?
 *
Describe any challenging behavior(s), how you respond to them, and ways in which you discourage the behavior(s).
 *
What three words best describe the participant?
 *
If the participant uses any communication devices or supports, please describe here.
 *
Describe how you reward the participant's positive behavior.
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How does the participant interact with others?
 *
Our soccer clinic consists of four sessions on the following dates: September 28th, October 5th, October 19th, and October 26th. It’s important for participants to attend all sessions to get the most out of the program. Can your child attend all four sessions?
 *
Please specify which dates they will miss below.
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