Rebounderz Respite Night

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This event is sponsored by The Hussman Foundation.
PLEASE REMEMBER TO FEED YOUR PARTICIPANT BEFORE THE EVENT BEGINS.
Event Timing: Monday, March 2, 2020 6:00-8:00 pm (Each family will be assigned a check-in time from 5:30-6:00)
Event Address: 12650 Patrick Henry Drive, Newport News, VA
Contact us at: kiki.jessup@tidewaterasa.org or 757-524-2980

Email *

Parent's first name: *

Parent's last name: *

Phone number (preferably cell for text reminders): *

How many children will be attending (max 3 per family)? *

First name(s), birthdate(s) (MM/DD/YY), AND age(s) of child(ren) with Autism (free) and children should be at least 4 years old *

First name(s), birthdate(s) (MM/DD/YY), AND age(s) of siblings (put NA if no siblings are attending, each sibling is $5) and children should be at least 4 years old *

Each parent must submit a 2020 Autism Society PARTICIPATION FORM for Rebounderz. *

I have already submitted a current 2020 Participation Form.

I will complete the participation section of this form.

I need to update my 2020 participation form.

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