STEP Registration STEP (Students Transitioning into Employment Program) Registration Please read the following information carefully before proceeding to the form.The STEP Program enables high school students to participate in targeted career development activities and exploration. With an individualized approach, students build self-awareness and skills through structured learning sessions and community mentorship placements with the ultimate goal of identifying employment or attending post-secondary choices upon school leaving. The STEP Program is suitable for students in Level 2 up to school leaving year. STEP is designed for students whose primary method of communication is verbal language; are comfortable working independently, or with minimal support; and are interested in exploring career options though work placements and/or attend post-secondary education. Whenever possible we encourage students to complete the registration themselves. Is your 2019/2020 ASNL Membership paid? Yes No Who is filling this form in?* I am filling out this form as a candidate I have a guardian/guidance counsellor filling out this form on my behalf Candidates Name* First Last Gender Male Female Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Candidates Email* Date of Birth:* Date Format: MM slash DD slash YYYY High School/level:*Age*Guardian Name (1) First Last Relationship to CandidateHome PhoneCellWorkEmail Guardian Name (2) First Last Relationship to CandidateHome PhoneCellWorkEmail Emergency Contact Person/Alternate Pick-up Person (other than above)* First Last Relationship to Candidate*Phone*Diagnosis / Other Medical Concerns (i.e.: Asperger’s, ASD, asthma, physical limitations, etc.):Does the participant have allergies? Yes No If yes, please list allergies, severity, and if an Epipen is required.Does the candidate experience seizures? Yes* No *an additional form will be completed upon registration If yes, please describe briefly.Sensory SensitivitiesTactileAuditorySmellMovementVisualOtherPrimary method of communicating: Verbal – participant communicates primarily through verbal language Partially verbal –participant uses few words/sentences but relies heavily on visuals or gestures Non-Verbal – participant does not use verbal language to communicate Please list any strong interests or preferred activities:Please list any aversions or non-preferred activities:When attending school or community-based activities does your participant require one on one supervision? Yes No If yes, please describe briefly.What community based activities or groups does your participant take part in? (i.e.: swim lessons, beavers, dance, etc.) Yes No If yes, please describe briefly.What community based activities or groups does your participant take part in? (i.e.: swim lessons, beavers, dance, etc.)When travelling to and from programs will the participant be: Dropped off/picked up by a parent/caregiver Taking GoBus Independently travelling (walking, taking transit and/or driving themselves) Please describe individual routines or tendencies that may be relevant to programming.What strategies help the participant when feeling overwhelmed or anxious (i.e.: take a break, go for a walk, etc.)Has the candidate completed Career 2201? Yes No What are the participant’s goals after completing High School? Post Secondary (College/University) Employment Training Program (Transitions, Employment Works etc.) Does the candidate have previous employment experience? Yes No If yes, where was the candidate employed and what tasks were they taking part in?Does the candidate have previous volunteer experience? Yes No If yes, where did the candidate volunteer and what tasks were they taking part in?What type of community access (i.e. lessons, leagues, clubs) is the participant currently engaged in?When taking part in community activities does the participant require supervision? If so, please explain the level of supervision they require (i.e.: one on one supervision)POLICIES AND PROCEDURES AUTISM SOCIETY, NL OFFERS QUALITY PROGRAM OPPORTUNITIES FOR INDIVIDUALS WITH ASD AND THEIR FAMILIES. TO ENSURE A SAFE AND SUCCESSFUL ENVIRONMENT FOR PROGRAM PARTICIPANTS AND STAFF, IT IS IMPORTANT THAT CAREGIVERS AND PARTICIPANTS UNDERSTAND AND ADHERE TO THE PROCEDURES OUTLINED BELOW. Drop-off and Pick-up • Participants in programming will be in session during the designated times only (i.e. 1:00 – 2:00 PM). • If a caregiver is unable to pick up the participant, alternative arrangements are to be made and staff advised accordingly. • Repeated late pick-ups will result in a meeting and subsequent late pick-ups will be addressed appropriately at the discretion of the Chief Executive Officer. • There are no supervised waiting areas available for participants to stay before or after the designated program time. Attendance • Any absences from scheduled programming should be communicated with staff as early as possible. • Three consecutive absences without prior notification may result in an withdrawal from the program (with an opportunity to re-register the following semester).. Payment of Invoices • It is the responsibility of caregivers to ensure invoices are fully paid before the program begins. • If a participant chooses to withdraw from programming, the caregiver is still responsible to pay the invoice in full. • If ASNL cancels a centre based program session a credit for $15 will be applied to the participants account.. • Outstanding invoices must be paid before a participant can successfully register for the subsequent semester of ASNL programs. Safety Concerns • In the event that a participant runs from the designated program space it is understood that staff will contact the designated caregiver immediately. It is the caregiver’s responsibility to ensure that the contact information ASNL has on file is current and s/he is reachable. • Where possible and ensuring that it does not jeopardize the safety of other program participants, staff will follow the participant in an effort to ensure their safety. If staff determines the potential of an immediate threat of harm/injury they will call 911 and request the assistance of authorities. • Staff may request a caregiver remain onsite during programming if the participant has emerging safety concerns, such as running from programming areas. While onsite it is the responsibility of the caregiver to follow their participant should they leave the program space (either onsite or off-site). • Staff carry contact information for participants and their caregiver(s) with them for all off-site activities in case of an emergency. • Staff are certified in Non-Violent Crisis Intervention® (CPI) and may use this training if there is an immediate threat of harm/injury. • Staff are certified in Emergency First Aid/CPR C/AED and will perform First Aid (i.e.: apply a band aid, provide ice, etc.) if needed. In the event of an injury during programming parents/caregivers will be notified. Consent for Information Sharing* I, as the parent/guardian of the above-named candidate, grant permission to share information with the guidance counsellor at my child’s school. I, as the parent/guardian of the above-named candidate, decline permission to share information with the guidance counsellor at my child’s school. I, as the parent/guardian of the above-named candidate, grant permission to share information internally. I, as the parent/guardian of the above-named candidate, decline permission to share information internally. Consent to share information will allow the coordination of quality, individualized programs for each participant. Information sharing will be limited to: • Individualized strategies and goals to support transitioning from high school; • Individualized strategies and routines to help with behavior/regulation; • Information shared at ISSP/IEP meetings. Designated Caregivers • For the protection of all program participants, please provide the names and phone numbers of individuals who would normally bring participants to and from programming. • If someone in addition to this list (unknown to staff) is picking up the participant the caregiver must notify staff ahead of time. Participants will not be released to an unfamiliar caregiver. • If a caregiver has sole custody of the participant, or if there are changes to a custody agreement, it is the responsibility of the caregiver to notify program staff of these changes. • Staff have the right to check identification of anyone picking up a participant from programming. Please list all designated caregivers and their phone numbersPolicies and Procedures Agreement I, as the parent/guardian of the above named participant, have read understood the policies and procedures outlined above and agree to all terms. Internal Information SharingProgram staff recognize that ongoing information sharing can enhance program experience and overall support/service to families and individuals. Specifically, consent to information share will allow the coordination of quality, individualized programs for each participant. Information shared among program staff may include, but is not limited to: • medication changes • specific challenges at school or in the home • individualized strategies and routines to help with transitioning • individualized strategies and routines to help with anxiety reduction and engagement in programs • information shared at ISSP/IEP meetings Consent for Internal Information Sharing I, as the parent/guardian of the above named participant, grant permission to share information internally I, as the parent/guardian of the above named participant, decline permission to share information internally Photograph Waiver* I, as the parent/guardian of the above-named participant, grant permission to use photos/videos. I, as the parent/guardian of the above-named participant, decline permission to use photos/videos. I hereby grant permission to Autism Society, Newfoundland Labrador (ASNL), and its representatives, to photograph and videotape my son/daughter, and otherwise capture their image. I further grant ASNL and its representatives the right to reproduce, use, exhibit, display, broadcast and distribute these images and recordings in any media now known or later developed for promoting, publicizing or explaining ASNL and its activities including their website. Such photographs are the property of ASNL and may be altered or combined with other images, text, and graphics without notifying me. Field TripsI, as the parent/guardian of the above named participant, grant permission for my participant to take part in off-site field trips.I, as the parent/guardian of the above named participant, decline permission for my participant to take part in off-site field trips.Throughout each semester many programs take part in off-site field trips. How often groups take part in field trips and where the group visits depend entirely on the groups interest. Please note: •Information regarding the location, time and cost (if applicable) will be sent to each family via email one week prior to the field trip. •Parents/caregivers are welcome to take part in fieldtrips. •Staff carry contact information for participants and their parent/caregiver(s) with them for all off-site activities in case of an emergency. • Participants will always meet the program staff at the decided upon location; staff never transport participants in their personal vehicles. STEP 2019/2020 Program Selection Mondays (3:30-4:30) Location: Elaine Dobbin Centre and community settings Cost: $15/hr Tuesdays (3:30-4:30) Location: Elaine Dobbin Centre and community settings Cost: $15/hr Thank you for your interest in the STEP Program. If you have additional questions please contact Sarah O’Grady, Coordinator, Career Services email@example.com or 722-2803 ex 232.