Register for our clubs

Name of Child / Young Person

Child/Young Person's Date of Birth

Select Club/s interested in Select Club/s interested in Gap Club: For children aged 9 - 13 Fusion Club: For young people aged 13 - 25 Arts and Crafts Club: For young people aged 14 - 25 Console Gaming Club: For young people aged 16+

Do they have a diagnosis on the autism spectrum or are they on the diagnostic pathway?

Name of Parent/Carer

Parent's Email Address

Parent's Mobile No

Home address of participant

Postcode

School/college attended

Level of support provided/needed