OWLS Registration Form – Down Syndrome Association of Hamilton

Participant Name *

Comments on Participant Needs

Use this space to identify any other needs or details related to the participant in the OWLS program.

Participant Interests and Activities *

How does the participant like to spend their free time? What extra curricular activities are they involved in? This information helps us to customize our activities.

Specific Learning Objectives

Wherever possible, we try to tailor the O.W.L.S. program to participant needs. Use this space to tell us about any specific goal areas the participant has.

Consent to Receive Speech & Language Services from professionals and or McMaster University students in Clinical Placement

Media Consent – I consent to the release and use of images, photos, videos and recordings in O.W.L.S. sessions which may include my participant and or their work.* *

Yes, I consent
No, I do not consent

*This includes but is not limited to engaging in the following activities for the benefit of the program and or the organization; filming, film/video editing, and film/video production; photography, photo editing, and photo production; digital photography, digital photo editing, and digital photo production; documentary production and editing; sound recordings; sound manipulation and music productions; television production; and web design and production for awareness, marketing, fundraising and other purposes relevant to the operations of a charitable organization.

Parent/Caregiver Name 1 *

Parent/Caregiver Name 2

Use if another caregiver can also pickup/drop off.

Main Contact Phone *

Emergency Contact *

Name and Phone Number

Email *

Additional Email *

Use this to add another email address to the contact list to receive all communications about this session.

Commitment to attend acknowledgement

I agree to commit to attending all sessions. Failure to attend may result in removal of the program or future sessions.

This program is subsidized by DSAH and provided for free to our members. Good attendance brings good results. Facilitators spend time planning and individualizing lessons, routines and activities for your participant. The program is currently waitlisted. If you cannot attend the full 8 week session please do not register at this time.