The C.I.R.C.L.E.

Creative Imaginary Really fun Learning Experience

An All Around Adventure
Join us Saturdays this winter season January 23rd- March 12th
For All Ages:
Session 1 10:00-11:00: Wizards. Princes. Monsters. Spirits. Magic. An Island.
C.I.R.C.L.E. is a fun hour where kids meet and are ready to play. It is based on Kelly
Hunters Heartbeat Method and introduces children to imaginative stories. Using
Shakespeares The Tempest kids will play games and take on different characters.
C.I.R.C.L.E. encourages childrens eye contact and facial expression, improve their
spatial awareness and language skills and introduces them to imaginative play. It is an
experience and an all around adventure. This group is led by Aaron Lopez who received
his Masters of Fine Arts from OSU in addition to extensive training from Kelly Hunter in
Hunter Heartbeat Method.
Session 2 11:00-12:00: Your childs journey continues as vision comes to life with art
and music. They will create their own adventure with a song story in music therapy.
Using drums, tone chimes, boom whackers and rhythmic instruments, creativity will
blossom while also practicing social skills, communication skills, and fine/gross motor
skills. The music portion of our group is led by Alexa Dorris, MMT, MT-BC. Alexa
received her Bachelors of Arts in Vocal Performance from Denison University and her
Masters of Music Therapy from Appalachian State University. She also maintains a
level 1 certification in Orff. In art group your child will discover new ways to create art
using various media and techniques producing individual and group masterpieces. Each
week is based on a theme that will allow your child's imagination to run wild! This group
will be split into two groups based on age. The Art portion of this group is led by Sara
Doucher, who received her Bachelor of Arts degree in Art Therapy from Capital
University.

For Siblings and Parents:

Session 3 10:00-11:00 SSG (Sibling Support Group): The theme of imagination
continues as siblings connect with each other on a deeper level. Social Worker and
Laughter Therapist, Marty Harrison, L.S.W.A. will lead the group in discussing such
topics as Three Wishes = What do I wish for my family?, My Family = How do I
explain my family to others?, Who can I trust? = Will my friends stand by me?, and
many more themes designed to engage your child in open communication with other
kids who have a family member on the spectrum.
Session 4 11:00-12:00 PSG (Parent Support Group): As your children ignite their
creativity you are invited to join other parents who are experiencing raising a child on
the spectrum. Social Worker, Marty Harrison, L.S.W.A. will lead group discussion with
such topics as "Riding the storm" = How do we handle day to day living?, "Magical
moments". = Those times when everything works, "Stand by me". = Loving them
through it, Is it my fault?= Could we have done something differently?, and many more
questions that parents of children with ASD may ask themselves.
*Please note siblings may attend sessions 1-3. Fee is based on materials/snacks.
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Pick your group(s):

Session 1/2 10:00 12:00

$400.00 (spectrum)

Session 1/2 10:00 12:00

$80.00 (sibling)

Session 2/3 10:00 12:00

$80.00 (sibling)

Session 3

10:00 11:00

$40.00 (sibling)

Session 4

11:00 12:00

Free

Please return your Enrollment form by December 11th 2015

(One form per child)
Name of Child: _______________________________________________________________________________________
Date of Birth:________________________ Parent Name:________________________________________________
Parent Cell Phone:___________________ Parent Email:________________________________________________
Address:_______________________________________________________________________________________________
_________________________________________________________________________________________________________
Emergency Contact Name/Number:________________________________________________________________
Medical Diagnosis:___________________________________________________________________________________
Medications:__________________________________________________________________________________________
Allergies:______________________________________________________________________________________________
Additional Notes about your child:_________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________

Will you be staying on campus during sessions:___________________________________________________

_________________________________________________________________________________________________________

Funding Source:
Autism Scholarship-TLS Students Only

Delaware County

Session 1/2 10:00 12:00

$400.00 (spectrum)

Session 1/2 10:00 12:00

$80.00 (sibling)

Session 2/3 10:00 12:00

$80.00 (sibling)

Session 3

10:00 11:00

$40.00 (sibling)

Session 4

11:00 12:00

Private Pay

Free

Total Amount:___________________________

I agree to pay the total amount, with the funding source as indicated above upon
enrollment. I acknowledge the amount indicated is for the 8-week session that begins
January 23rd and ends March 12th. I understand that if my child should fail to attend any
portion of this offering there will be no refund or pro-rated amount returned to me. If TLS
should happen to close due to weather related or unforeseen circumstances an additional
week will be added to the offering. If I cannot attend the additional session being offered I
acknowledge there will be no refund or pro-rated amount returned to me.
____________________________________________
Signature

________________________________________
Date: