Free Haircuts for Neurodivergent Individuals

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We understand that typical haircut environments can be overwhelming for individuals with sensory sensitivities or developmental disabilities. Our goal is to provide a safe, accommodating, and enjoyable experience tailored to the needs of neurodivergent individuals and their families.

This program offers free haircuts in a supportive setting, with adjustments to ensure comfort and care. Please complete this questionnaire so we can better understand your needs and create the best possible experience for you.

Personal Information

Child's Name *

First & Last

Age *

Zip Code *

Email *

Required to book your appointment

Phone number

Verification of Developmental Disabilities

Do you (or the person receiving the haircut) identify as having a developmental disability or neurodivergence (e.g., autism, ADHD, intellectual disability, sensory processing disorder, etc.)?

Yes

How would you prefer to confirm eligibility for this service? (Check all that apply):

Providing a document, such as: An Individualized Education Program (IEP), A doctor’s note or diagnosis letter, A service plan from a developmental disabilities organization

Self-identification and a description of specific needs

Referral from a trusted organization or community advocate

No Documentation

Other:

Required

If no documentation is available, can you provide a brief description of how we can best support your specific needs?

Privacy and Confidentiality Disclaimer:

Any documentation provided will be used solely to verify eligibility for this program. All personal information will remain confidential and will not be shared with any third parties.

Sensory Preferences

Do you have sensory sensitivities to sounds, touch, or smells?

Yes

Other:

Clear selection

Do you prefer a quieter environment?

Yes

Clear selection

Are there specific materials or tools that make you uncomfortable (e.g., clippers, hair products)?

Yes

Other:

Clear selection

Communication Preferences

How do you prefer to communicate with the stylist?

Verbally

Using gestures or visual aids

Other:

Clear selection

Do you prefer limited conversation during the haircut?

Yes

Clear selection

Would you like to visit the space ahead of time to get familiar with the environment?

Yes

Clear selection

Preparation and Accommodations

Are there any specific accommodations you’d like us to provide? (e.g., noise-canceling headphones, weighted blankets):

Haircut Preferences

What type of haircut are you looking for?

Trim

Style change

Other:

Clear selection

Do you have a photo or example of the haircut you’d like?

Yes

Clear selection

Scheduling Preferences

Day: Mondays ONLY

Time: 2:00pm to 7:00pm

First come first serve

What date do you prefer your haircut appointment: *

What date do you prefer your haircut appointment:

Second option

What date do you prefer your haircut appointment:

Emergency Contacts (Optional)

Name:

Phone Number:

Additional Notes

Is there anything else you’d like us to know to make this experience comfortable for you?

Submit

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