Welcome to Circle of Friends
Where Autism is Everyone’s Undertaking!
C/O Lighthouse Christian Academy
2440 US Route 60
Hurricane WV 25526
304-881-0245 (phone)
866-332-2962 (toll-free fax)
Circle of Friends, Inc.,
C/O Lighthouse Christian Academy
2440 US Route 60
Hurricane , WV 25526
ph: 304-881-0245
fax: 866-332-2962 (toll-free)
info
***Summer Programs 2009 ***
June 15-25 Summer Fun with friends
July 5-16 Summer Fun with friends
August 10-20 Ready for school skills camp
Lighthouse Christian Academy
2440 US Route 60
Hurricane WV
(Just past Culloden on route #60)
Board Certified Behavior Analysts & SLPs
State-of-the-art programs
Classroom & “daycamp” settings with typical peers
For: Children with Autism Spectrum Disorders
Ages: Preschool through age 12
Focus: Social and Language Skill Development in
Naturalistic and **Discrete Trial Settings
Utilizing Theme-Based Activities with typical peers
All sessions Monday through Thursday 9:00—3:00 Bring your own lunch
June & July Summer Fun Camps $200 per week
($150 if you bring your own staff)
August skills camp $480 per week.
$50 non-refundable Registration Fee Due by May 22, 2009. $25 will go toward tuition.
Register Today!
First come, first served.
Cut and paste the registration form below.
Once completed you can scan it and e-mail it to info@circleoffriendsaba.com
or Fax it to : 866-332-2962
or Mail to:
Circle of Friends
C/O Lighthouse Christian Academy
2440 US Route 60
Hurricane WV 25526
Questions or need more information
Please call us at 304-881-0245
or e-mail us at info@circleoffriendsaba.com
Child's Name__________________________________________ M/F (Circle)
Address____________________________________________________________
City____________________________________ State_______ Zip__________
Home Phone#________________________________________________________
E-mail Address_____________________________________________________
Age____ Date of Birth________ Grade completed as of June 2008 _____
Parents'/Guardians' Names__________________________________________
Other numbers where parents/guardians may be reached (work, cell, etc.)
___________________________________________________________________
___________________________________________________________________
ALTERNATIVE CONTACT - for emergency and you cannot be contacted:
Name/Relationship__________________________________________________
Phone Number(s)____________________________________________________
MEDICAL INFORMATION
Dates of last immunizations: (please provide a copy also)
MMR___________ DPT___________ Polio__________ Chicken Pox__________
Tetanus_______ Hep B_________ HIB____________
Allergies:_________________________________________________________
___________________________________________________________________
___________________________________________________________________
MEDICATIONS List below, with doses and times
___________________________________________________________________
___________________________________________________________________
MEDICAL CONDITIONS (including ADHD)
___________________________________________________________________
Physician name and number__________________________________________
Insurance name and policy__________________________________________
Circle of Friends, Inc.,
C/O Lighthouse Christian Academy
2440 US Route 60
Hurricane , WV 25526
ph: 304-881-0245
fax: 866-332-2962 (toll-free)
info
