Yoga/Stretch Class Yoga/Stretch Class Parent/Guardian Name* Child's Name* Child's Age* Address* City/State, Zip* Phone Number* Email address* Information about your child:If your child does not attend Jackson Autism Center, please give some background information about him/her, likes/dislikes, things that may upset him/her, etc.Check the items your child can do:* Follow simple directions. Follow directions involving prepositions (up/down/under/over). Imitate motor movements. My child is NOT typically upset by touch. Typically uses 1 or more words to communicate. What benefit(s) do you see a yoga/stretch class having for your child?* Relaxation Stretching More aware of his/her body in space Making friends Additional activity during the week Other Other Would you be interested in a weekly yoga/stretch class?* Yes No Maybe
