YAST - Fall 2019 Registration

Please complete this registration intake form. 
*Young Adult Social Time group is meant for individuals (18 to 28 years old) who are already able to access the community independently and who can participate in the group without 1:1 support.  Families and Caregivers are welcome to wait outside for participants during group sessions: in-house and community activities are for participants and YAST support staff. 
Once your registration is received one of the staff members from Young Adult Social Time group will be in contact with you prior to starting group sessions. If you have any questions, please call Teresa at 250-751-9278. 
This group is supported by Autism BC, Nanaimo Child Development Centre and the Nanaimo Association of Community Living.

*Remember a YAST Staff member will be in touch Monday or Tuesday the week before group start up with more info and to confirm your registration. 
Thank you for completing all questions on this intake form. Information will be used only for the purposes of this group and not shared outside the YAST staff and organizers.

Question Title

* 1. Please tell us about yourself:

Question Title

* 2. Any Medical concerns that could be present while you are attending group, if yes please describe so staff can support you in best way possible?

Question Title

* 3. Your Hobbies or Interests? (What do you like to do in your free time)

Question Title

* 4. Do you need help with any of the following?  (Please check all that apply)

Question Title

* 5. Please check any of the following that affects you?

Question Title

* 6. What do you hope will happen for you by attending this group for 7 weeks:

Question Title

* 7. Emergency Contact info:  (Contact person over the age of 18 in case of emergency)

Question Title

* 8. Additional Person to contact with program info if unable to contact you?

Question Title

* 9. How did you find out about Young Adult Social Time?

Question Title

* 10. Thank you for completing all questions on this form, if there is anything else you'd like us to know please tell us in comment box below :-)

T