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Chesapeake Respite Night (Registration Information)

September 23 @ 5:30 PM - 7:30 PM


**Chesapeake Respite Night Program**

**Saturday, September 23rd, from 5:30 – 7:30 PM**

*Hosted by the Autism Society Tidewater Virginia*

at We Rock the Spectrum Kid’s Gym Chesapeake

211 Providence Road, Unit 1-3

Chesapeake, VA 23325

Parents/Caregivers – Take a Break!

Kids/Young Adults – Enjoy Sensory Play & Social Time!

The Autism Society Tidewater Virginia, a local non-profit serving the Autism community for the past 42 years, is pleased to announced that our Chesapeake Respite Night Program is BACK and at a new location!

This program offers parents/caregivers a much needs break, and kids (ages 4 and up) and young adults an opportunity for sensory plan and socialization. We are grateful for continued community support to make this program a possibility. ***Children and young adults with Autism are free, and we kindly ask for a $5 donation for each sibling.***

Spots are limited to 15 children (ages 4-17) with a 3 child per family limit. Participants must be able to toilet independently or have a caregiver stay to assist with toileting needs. Our volunteers cannot change diapers, pull-ups or do standing changes for adults.

**Please follow the (3) step process below to complete your registration.**

**Step 1: Complete Program Registration Form: [https://tidewaterasa.formstack.com/forms/chesapeakerespitenight](https://tidewaterasa.formstack.com/forms/chesapeakerespitenight)**

**Step 2: Complete Program Waiver Form: [https://tidewaterasa.formstack.com/forms/astv_respite_participant](https://tidewaterasa.formstack.com/forms/astv_respite_participant)**

**Step 3: Register with We Rock the Spectrum Kids’ Gym**


We will confirm program slot(s) via email & text and request that you complete a participant profile so we know more about your loved one and their needs. It is important that our volunteers be aware of any communication preferences, behavioral and functional needs, and their interest preferences. If we are unable to offer your loved one a spot, then we will let you know as to why or if we need additional information. Finally, if we did not have spot available, then we will let you know that your loved one(s) have been added to our waiting list. Thank you for taking the time to complete the (3) steps above.

On behalf of the Autism Society Tidewater Virginia, we are thrilled to bring this program back to our local community. A huge thank you to our partners at We Rock the Spectrum Kid’s Gym!


September 23
5:30 PM - 7:30 PM


We Rock the Spectrum – Chesapeake
211 Providence Rd suite 3
Chesapeake, VA 23325 us