Name
*
First Name
Last Name
Age of Participant
Email
*
Phone
*
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
LET'S MOVE
SpecialFit Workouts- Individual
SpecialFit Workouts- Family
SpecialFit Workouts- Group
Physical Therapy
Hiking Club
Indoor & Outdoor Sensory Activities (rock climbing, bike riding, obstacle course, etc)
LET'S SPELL
Spelling to Communicate/Letterboarding- Beginner
Spelling to Communicate/Letterboarding- Fluent Communicator
Independent Typing
AAC devices
LET'S COMMUNICATE
Occupational Therapy
Speech Therapy
Music Therapy
Interactive Metronome Therapy
LET'S GATHER
Weekly Learning/Ongoing Subject Series
Monthly Lectures/Special Guest Speakers
Special Interest Groups/Clubs
Book Clubs
Parent/Family Tips & Tricks meetings
Social Outings (Braves Games & other sporting events, bowling, picnics, field trips, etc)
Community Fundraising Opportunities
Will you and your family be fully involved, or would your participant require the services of a communication aid during ReClif activities?
Comments regarding the services section:
ALOT! 3 - 5 times per week // We have been looking for a place like this!
ACTIVELY INVOLVED 1 - 2 times per week // We already have great individual therapists with no need for more services of that type, but will utilize group activities, clubs and social options!
SOMEWHAT INVOLVED 2 - 4 times per month // We are already pretty busy but would like to connect more with a vibrant, encouraging community!
RARELY INVOLVED 1 time per month or less // We are interested only in specific activities or events.
Comments regarding facility/services utilization:
General comments or questions: