Event Registration
Please fill out all required fields to complete your registration.
Only children with a condition of Autism or TDAH (ADHD)
Parent Information
Parent First Name
*
Parent Last Name
*
Phone Number
*
Parent Email Address
*
Children Information
Add Child (1/3)
Child 1
(Primary - determines time group)
First Name
*
Last Name
*
Age
*
Medical Condition
*
Select an option
Autism
TDAH (ADHD)
Has Insurance?
*
Select an option
Yes
No
Event Information
Event Schedule by Age Group:
Ages 3-6 years:
8:00 AM - 10:00 AM (50 spots per date)
Ages 7-12 years:
11:00 AM - 1:00 PM (50 spots per date)
Event Date
*
Select an option
March 14, 2026
March 15, 2026
Submit Registration
