Valparaiso University Occupational Therapy Inclusive Nature Play Day 
Please complete the following form to help us plan for our Inclusive Nature Play Day on June 7, 2023 at 10:00am. 
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Email *
Parent/caregiver name  *
Parent/caregiver email *
Number of children who will be attending  *
Ages of children attending  *
We need an accessible nature walk path for a wheelchair or stroller in order to participate in this event
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We need a sensory break space or quiet corner in order to participate in this event (Note: A sensory break space is usually a quiet area where individuals can spend some time if they feel overstimulated or overwhelmed). 
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Please describe any other accommodations that you or your children may need in order to participate in this event. Please do not hesitate to suggest accommodations - we are committed to doing all we can to allow all children to participate! 
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