OWLS Registration Form – Down Syndrome Association of Hamilton

Participant Name *

New or Returning Participant? *

New
Returning

I am registering for *

While we make every attempt to place same aged peers together, we do reserve the right to change the group ages at any time.

This program is waitlisted.

We encourage you to fill out the form below. If a spot becomes available we will contact you.

This program might be waitlisted.

We encourage you to fill out the form below. If a spot becomes available we will contact you.

Participant Age as of Oct 1 2026 *

Participant Grade *

n/a if not in school

What School Board does your participant attend?

Participant Support Needs:

Use the space below to provide more details or other support needs.

Provide more details about support needs here if needed;

Specific learning objectives/goals for the participant: *

What do you hope the participant gains from attending?

Speech and Language Services *

Yes, I want my child/adult to receive speech and language services for the duration of the program.
No, I do not want my child/adult to receive speech and language services for the duration of the program.

Speech and Language Services are provided by Monica Knott and / or Natalie May, SLP and paid for by DSAH.

Participant Strengths *

Participant Challenges *

Participant Interests & Extra Curricular Activities *

Tell us about things your student is interested in. How do they like to spend their free time? What other activities do they participate in?

Parent Caregiver Name *

Parent Caregiver Name 2 *

Phone *

In case of emergency, this is the number we will contact.

Parent Caregiver Phone 2 *

Email *

Media Consent

Grant of Permission
I hereby grant The Down Syndrome Association of Hamilton (DSAH), its representatives, and employees irrevocable permission to photograph, videotape, record, and/or otherwise capture my image, likeness, voice, and performance (collectively, the “Media”).

Permitted Uses
I understand and agree that the Media may be edited, copied, exhibited, published, or distributed in any form of media now known or hereafter devised, including without limitation, websites, social media platforms, promotional materials, advertising, annual reports, and press releases, for any lawful purpose deemed appropriate by DSAH.

Release of Liability and Waiver
I release DSAH, its officers, employees, and agents from any and all claims, liabilities, or demands arising out of or in connection with the use of the Media, including any claims for defamation, invasion of privacy, or infringement of moral rights.

No Compensation
I acknowledge that I am participating on a voluntary basis and that I will not receive any financial compensation, royalty, or other payment of any kind in exchange for the grant of these permissions or the use of the Media.

Acknowledgment
I am 18 years of age or older (or have obtained parent/guardian consent below) and am legally competent to sign this release. I have read this release before signing below, and I fully understand the contents, meaning, and impact of this consent.

Media Consent *

I agree
I do not agree

Acknowledgement

This program is provided at low or no cost to our members. Space is limited. Participants are asked to commit to attending all sessions in order to fully benefit. Not attending regularly will result in removal from program and your spot will be given to another family on the waiting list.

I understand *

Yes
No