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Sensory Haircuts Sign Up
If there is a cancellation, we will also contact individuals via email.
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* Indicates required question
Email
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Your email
Parent/Caregiver Full Name
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Your answer
Phone Number
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Your answer
Mailing Address
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Your answer
Child(ren) needing a haircut's full name.
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Your answer
Age(s)
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Your answer
What time frame works best for your family? We will contact you directly to confirm a time slot. Please note filling out this form does not guarantee an appointment. Appointments are on a first come, first served basis.
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10:00am-12:00pm
12:00pm-2:00pm
anytime between 10:00am-2:00pm
Tell us about your last haircutting experience. (if applicable)
Your answer
Are there any sensory challenges you would like us to be aware of prior to your arrival?
Your answer
Please list any behavior challenges we need to be prepared for. Ex. aggressiveness, spiting, biting, self-injury, elopement, hair-pulling, scratching, screaming, etc.
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Your answer
Positive reinforcers. Please bring with you any preferred items such as electronics, blankies, stuffed animals, etc. We will have an assortment of items available if needed.
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I will bring my reinforcers for sure!
We will need help to figure out what works for our child/children
Our stylists will do their best to accomplish a full haircut for each child. Coming into this event, each parent should be aware and know the possibility of leaving with no haircut, or a partial haircut. All measures are in place to make this event as successful as possible for each family.
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Yes, I understand the statement above.
Parents and caregivers must stay throughout the event.
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Yes, I /we will be there!
Would you like to be added to email distribution list?
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Yes - Sign me up!
No thank you
I'm already on that list
Release of Liability - I am the parent or legal guardian of the Participant. I have read this document, and I am signing it freely. I understand the legal consequences of submitting this document, including (a) releasing Collaborating Autism Movement from all liability on my and the Participant’s behalf, (b) waiving my and the Participants’ right to sue Collaborative Autism Movement, (c) and assuming all risks of Participant’s participation in this Activity. I allow the Participant to participate in this Activity. I understand that I am responsible for the obligations and acts of the Participant as described in this statement. I agree to be bound by the terms of this document by submitting it prior to attending this Activity.
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I agree
Any questions or comments can be added here.
Your answer
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