aMAYSing Kids Integrated Media Program April 2024

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Hello Parents/Guardians

We are truly excited for your child to be part of our Integrated Media Broadcast Program! Our Integrated Media Broadcast program intentionally serves children with Autism Spectrum Disorder (ASD). As most people already know, we strive to be inclusive and work diligently to foster an experiential learning environment of belonging. We strive to empower our youth by providing engaging programming and creative to help children reach their fullest potential.

Please fill out the registration form below to ensure your child's spot to be part this unique program. Sessions are hosted at the Lucas County Public Library-Mott Branch. If you have any questions or need assistance with registration, please feel free to reach out to Tisha Mays - Executive Director, or Site Coordinator Crystal Smith. Contact information is below.

Would you like to opt in your email to aMAYSing Kids Broadcasting and Media Mentorship Program?

By providing your email on this part of the registration form, you will receive updates about aMAYSing Kids, newsletters, emails containing valuable information on your favorite aMAYSing Kids, and staying involved in our local community.

OPT in now. Stay connected to empowering our future generation.

Please Provide Email in space below.

First and Last Name of Child: *

Age: *

Grade at the start of 2024/2025 school-year: *

School: *

Dietary restrictions/food allergies

(Ex: Child is allergic to Peanuts, Egg, Milk)

Please provide any information about how we can better assist your child.

Shirt Size: *

Select Your Session (only one session can be selected) *

Session 1: April 8th- 11th 3:15pm- 4:30pm

Session 2: April 16th- 18th 3:15pm- 4:30pm

Session 3: April 22nd- 25th 3:15pm- 4:30pm

How will your child be arriving to the program? *

Ride (parent/guardian)

Ride (another adult MUST BE LISTED BELOW with PROOF OF ID)

Walk

Bus

Other:

How will your child be leaving program? *

Ride (parent/guardian)

Ride (another adult MUST BE LISTED BELOW with PROOF OF ID)

Walk

Bus

Other:

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms