EVENT FULL
Our special santa event is now full. To be added to our waiting list please complete the form below and we will try to accommodate your family. Please check your email often.
* Required Field

*Parent's Name:


*Address:
*City:
*State:
*Postal Code:
*Phone Number:
*Email Address:
(to include you on future event mailings)
*Childs name:
*Childs age:
*Diagnosis:
*Childs school:
Something your child would like for Christmas: 1.
2.
3.
Anything else Santa's Helpers should know when it's your child's turn?:
What does the photographer need to know about your child with autism that will help the photo session be more successful? (ie., things he/she doesn't like, what are favorite things) :
 
Other Children Name:
Other Children Age:
   
   
NOTE: If you would like the child to look at the camera, it may be helpful to bring along an item that the child is fond of so photographers can hold it close to the camera.

Photo Release Form

On many occasions newspapers, TV stations, etc., will contact Autism Society and pictures taken may be used. Signing this release will include giving permission for us to possibly use you or your child's picture in promotion and advertising for the program. It is understood that no compensation will be given by Autism Society of Mahoning Valley for use of these photographs. These photos also may be put on the Autism Society Facebook page. This agreement and waiver having been read thoroughly and understood completely, is accepted voluntarily.
By checking this box I am accepting the terms of this release form
Date: