HighPointe Services - Exceptional Kids Sign Up Form

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Sign Up Form

Exceptional Kids is a free monthly kids club for children with disabilities and their families. Each month has a fun theme with games, activities, and food in a welcoming environment.

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Family Contact Information

Parent/Guardian First Name

Parent/Guardian Last Name

Phone Number

Participant Information

Child's First Name

Child's Last Name

Grade

Gender

Tell us anything that will help us serve your child best (Ex: Disability/Diagnosis)

Siblings Name and Age (Ex: John - Brother- 10)

We want every child to feel welcome, supported, and included. Please select the options below that apply to your child. You may also add details where needed.

⚙️ Mobility & Accessibility

Uses a wheelchair

Uses a walker, cane, or braces

Needs assistance moving between rooms or outdoor spaces

Has difficulty with certain surfaces (stairs, grass, uneven ground)

🧠 Developmental & Sensory Supports

Sensitive to loud noises

Sensitive to bright lights

Sensitive to textures or touch

Sensitive to large groups or crowds

Benefits from sensory tools (noise-canceling headphones, fidgets, weighted items, etc.)

Benefits from sensory tools (noise-canceling headphones, fidgets, weighted items, etc.)Choice

🗣️ Communication

Speaks verbally

Uses sign language

Uses a communication device/tablet

Uses gestures or pictures

Needs extra support understanding instructions

Emergency / Safety

Emergency Contact Name

Emergency Contact Relation

Guardian

Parent

Sibiling

Grand Parent

Other

Emergency Contact Phone Number

Photo Release: We may take photos during the event for nonprofit promotion. Check if you are or aren't okay with photos being taken.

Yes

Please list any Dietary Restrictions. If not applicable, please write NA

Waiver/Consent

Waiver Signature

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About

We exist so families living with Intellectual and Developmental Disabilities will NEVER be ALONE. Because at HighPointe, we are truly YOUR PARTNER for LIFE!

Address: 7323 S. Alton Way
Centennial, CO 80112
Phone: (303) 221-3222

What we do

Residential Services
Life Management Services
Community Services
Personal Growth Services
Recreation Programs

Support Us

HighPointe Services is a non-profit organization established to provide services without the pressure to provide a return on investment to investors. Your financial support is critical to our long-term success in serving our clients. Please consider providing a financial donation. It will be a blessing for hundreds of our clients.

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