Adult Day Program Application 2022

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

The Arts for Autism Academy will provide a variety of job readiness and life skills programs through the creative arts for the Autism community of South Florida ages 18+.
These programs will be for those who are not school age- focusing on Adult services, and parent resources.
Daily activities include:

Art/Music/Dance Therapy
Job readiness
Social hour activities
Advocacy Training

Tuesday/Thursday (12 weeks)
9am-12pm

Royal; Oaks Park
16500 NW 87 Ave
Miami Lakes, Fl 33018

Adult Day Program Fees
Miami Lakes Residents $80/week
Non-Residents= $90/week
Registration fee= $25 (due with final registration)

Forms of payment:
Private pay (no insurance)
Arts for Autism Scholarships (upon availability)
Miami Lakes Special Needs Advisory Board Scholarship (upon availability)

Minimum of 8 students

You will be notified once we have reached our 8 student minimum with official start date. By applying for the program you are automatically applying for scholarship funding through the Arts for Autism Foundation & SNAB of Miami Lakes.

Email *

Today's Date *

YYYY

Student's Name *

Date of Birth

YYYY

Caregiver Name *

Email *

Full Address *

Phone number *

Does the student require additional supports? *

Yes- Please describe in the comments

Is the student available Tuesdays & Thursdays 9am-12pm? *

Yes

How many students are you enrolling? Include name to link siblings. *

Does the student have a private therapist/aide that will join the class? *

Yes

Have you taken any AMA teaching online course? *

Yes- learned so much!

No- but will look into it...

is the student currently employed? *

Yes- but it did not work out

No- this will be their first time

What is the student's shirt size? *

Does the student have behavioral concerns? *

What are the student's special interests/talents? *

Anything else we should know about this student?

Comments

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms