ASD Fit
NEW Client Form

Please fill out the form and submit the form below. After we review the information, we will contact you regarding the following steps.

Participant First name

Participant Last name

Parent or Legal Guardian Name

Parent/Legal Guardian Email (This is our main source of contact)

Parent/Legal Guardian Mailing Address for correspondence

Participant Date of Birth

Month

Day

Year

Participant Detailed Diagnosis (ASD, CP, TBI, Genetic Disorder, ADD/ADHD, etc.)

List any physical, mental, emotional, cognitive or other concerns that would help us understand participants needs

Does Participant use a wheelchair, walker or cane (Yes/No)

Participant Medications

Will participant pay for sessions privately or with special funding (please explain and list name and contact info if using special funding - if unsure write 'Unsure')

ASD Fit Boston Fees: I understand the fees associated with ASD Fit Boston sessions as described. ASD Fit Bostonwill collaborate with state or agency 3rd party funding to assist with payment on an individual basis . If assisted funding is not available or becomes unavailable during the course of time and individual comes to ASD Fit Boston, I understand I am fully responsible for all fees incurred. There will be a $25 fee for any returned checks or declined credit card payments

Cancellation Policy: ASD Fit Boston requires 24-hour notice to cancel a scheduled work out session. If a 24-hour notice is not given, ASD Fit Boston will still charge the per session fee for that scheduled visit. We understand many things are beyond our control and we want to be as accomodating as possible. Without a 24-hour notice of cancellation we may be unable to fill that session with another client waiting to get in.

Coaching Staff: All ASD Fit Boston coaches work together to deliver a great work out experience. Our coaches are trained in adaptive fitness and work hard to develop new ideas and techniques to bring out the best in everyone. Individually our coaches bring different styles and methods to a workout, and it is important for each client to have the opportunity to work with each coach on our team. We will do our best to accommodate a preferred coach when possible.

Social Media Consent: We like to show off all of the great things happening at ASD Fit Boston on our social media platforms and website. Please let us know if we have permission to post photos, videos, images of you or your loved one.

YES, I give ASD Fit Boston permission to use photos, videos, images of myself or my loved one to post publicly on ASD Fit Boston social media platforms and websites

NO, I DO NOT give ASD Fit Boston permission to use photos, videos, images of myself or my loved one to post publicly on ASD Fit Boston social media

Signature Parent/Legal Guardian or Participant

Today's Date

Month

Day

Year

ASD FIT

A LEADER IN ADAPTIVE FITNESS

ASD Fit
NEW Client Form

ASD Fit NEW Client Form

ASD Fit
NEW Client Form