May Family Outing
The Walnut Grove (inclusive playground) - 8800 Columbiana Canfield Rd.
Canfield, OH 44406
Thursday, May 11, 2023 from 5:30-7pm
Let's Play! Fun event for children of all ages with autism and their siblings.
We will have support staff to assist.
Chips and Drinks are provided too! Feel free to bring your dinner.
Let's start Spring with some outdoor fun!

Covid Requirements:
Please take temperature the morning of the event to make sure you are well. If you have any of the following health issues please do not attend, these are the CDC guidelines for symptoms.
Also, if someone in the family isn't feeling well, please do not attend. If you have been in direct contact with someone in the past 14 days with COVID please do not attend this event. There is no need to call to cancel for this event.
The Autism Society of Mahoning Valley, its board members and its partners are not liable for any exposure to COVID directly or indirectly. By attending you agree to this liability waiver.
Any cancellations will be listed as an event post, so please check the day of the event.
Read all the requirements HERE
Accept Covid Terms and Conditions

* Required Field

*Parent's or Caregiver's Name(s):


*Address:
*City:
*State:
*Postal Code:
*Phone Number (Home):
*Phone Number (Cell):
Phone Number (Other):
*Email Address:
(to include you on future event mailings)
Preferred Contact Method:
Home, Cell, Other, Text, Email
Total # of Individuals on the autism spectrum attending:
*Total # of siblings not on the autism spectrum attending:
*Total # parents attending (needed to reserve tables at Buffalo Wild Wings):


Children Information:
 
*Name:
*Age:
*Diagnosis (if applicable):
Name:
Age:
Diagnosis (if applicable):
Name:
Age:
Diagnosis (if applicable):
Name:
Age:
Diagnosis:
Name:
Age:
Diagnosis (if applicable):
Name:
Age:
Diagnosis (if applicable):


What types of programs would you like the Autism Society of Mahoning Valley to provide for your child and/or for your family? :


I give permission and consent to allow photographs to be taken during Autism Society of Mahoning Valley activities. I further give permission and consent that any such photographs may be published and used by Autism Society of Mahoning Valley and its agents, to illustrate and promote its programming and fundraising efforts.

Furthermore, I grant the Autism Society of Mahoning Valley, its representatives and employees the right to take photographs of me and my property in connection with the above-identified subject. I authorize the Autism Society of Mahoning Valley, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Autism Society of Mahoning Valley may use such photographs of my family with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I have read and understand the above:
By Submitting this form, I am registering for the event and accepting the terms of this release form.






Mahoning Valley Office
330-333-9609
autismmv@gmail.com
https://autismmv.org