Spiral Movement Center

Adapted Spiral Praxis Permission Form

Welcome to the ASP Intensive—we hope that your stay with us will be enjoyable and transformative for your child. We request that you fill out the registration form below which contains important information that we’ll need for your stay here. Please note that video documentation is an important part of the therapy process here and if you have any questions or concerns about filming, please don’t hesitate to contact us. Thank you for your interest in our program 🙌

I. Personal Information

Who can be contacted should an emergency arise?

II. Photo/Video Consent and Pick-Up/Drop-Off Information

Videos are required for remote assessment—these videos are completely confidential and will be used to please use the free service WeTransfer to send large video files to us. You can begin by pressing the WeTransfer button below. If you need additional guidance, please watch our tutorial on transferring videos. Any other files you need to send to us, such as photos or important documents, can also be sent via WeTransfer.

Tutorial: How to Transfer Large Videos

Airport Pickup

For small families, the Spiral Movement Center offers free airport pickup on your arrival. Please note however that our vehicle is small and can only fit 2-3 passengers and their luggage. For larger groups, we recommend calling a taxi. Please view our Visitor Guide below for information on taxi services.

III. Participant Release Form

I accept responsibility for my child's own medical coverage. I hereby give permission for staff/ volunteers of Spiral Movement Center, to arrange for any emergency medical care including hospitalization and transportation if necessary, and agree to pay for all expenses and cost incurred thereby. If emergency medical care is required, attempts will be made to contact emergency contact person(s) shown above. I agree to release and Indemnify and save harmless Spiral Movement Center, c.o.b. Stephanie Gottlob and Yuji Oka and their staff from all claims arising from whatever participation in any program organized by the staff or volunteers of Spiral Movement Center by any cause whatsoever. Please note that this form with its legal consents and liabilities remains in effect from the date it is signed and will apply to any future Spiral Movement Center programs that the above named participant is registered in unless advised otherwise in writing. I, the undersigned, have read and fully understand the "Participant's Release Form".

IV. Refunds/Cancellation Policy

Due to the logistical requirements necessary for children’s intensives, we require that payment be provided well in advance of your arrival. All intensives are scheduled on a first-come, first-served basis. In the event of a cancellation, we will offer a full refund up to one month prior to the scheduled intensive, and a 50% refund up to two weeks prior. We will not be able to provide refunds after this period.

V. Additional Needs/Requirements

If you have any additional needs or requirements, please let us know in the field below or by writing us at: info@adaptedspiralpraxis.com. We will be able to provide accommodation or adjustments depending on you and your child's specific needs.