ADHD League - Intake Form
This document is to register your child for the ADHD League, starting on September 27, 2020.  Please complete this form to the best of your knowledge and someone from our team will contact you if clarifications are required.
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Email *
Your name *
Your phone number *
Your address *
Your child's name and age *
Where did you hear about this program? *
Pricing option: *
List of current behaviours/challenges:
Safety concerns: *
Interests and strengths: *
DISCLAIMERS - By submitting this intake document, I confirm I have disclosed all my child’s behaviours and safety concerns to the best of my knowledge. 
I confirm that if my intake form lists destruction of property, physical aggression with peers/staff, or fleeing of property/area, my child cannot participate in this program. *
Safety and Cancellation Policy - The following behaviours will result in a cancellation of planned programming : 
1-Verbal aggression (swearing, threats, yelling at others) 
2-Destruction of Property (punching walls, kicking furniture, throwing obstacle course or school equipment etc.) 3-Physical aggression (kicking, punching, pushing, etc.) of other persons or staff 4-Fleeing the property or area Excessive, intentional self-harm that impacts individual’s safety. 
 *
Refund Policy - COVID-19 CLOSURE: Should the program require to be cancelled due to Government mandated restrictions, prior to opening, all clients will receive a 100% refund.  If the camp is cancelled while it is in operation, clients will be refunded to the pro-rated amount of Sundays remaining in that month.    Departure with cause: Should a client need to remove a child with due cause (such as illness or injury) clients will be refunded to the pro-rated amount of Sundays remaining to the camp.  Departure without cause: Should a client opt to remove their child from camp without due cause or due to issues mentioned in the Safety and Cancellation policies above or due to a failure to abide by a safety plan, no refund will be issued. *
PAYMENT POLICY:  To finalize their registration, clients must make the first month's payment upon receipt of the invoice.  Clients will then receive a payment option for monthly payments.  Failure to abide by the payment agreement will result in a cancellation.  The first payment must be made by Interac e-transfer or via credit card over the phone.  If paying by credit card, a 5% surcharge will be applied to the payment. *
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