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Life Skills Cooking Program
Child's First and Last Name
*
Guardian's First and Last Name
*
Email
*
Phone
*
Birthday
*
Month
Day
Year
I need individual support ($25/h)
How does your child communicate?
*
Speaking
Non-Speaking
AAC device
Visuals
Gestures
Please list any allergies
Please list all the triggers:
Please describe de-escalation procedure:
How would you like to pay?
*
AFU
E-transfer/credit card
Other
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