Get S.E.T. Registration Form

Thank you for your interest in Successful Living with Autism through Training and Education (SLATE). SLATE is a program offered through Rowell in Shasta County, and is partially funded by Far Northern Regional Center. 

Your child must have a diagnosis of Autism Spectrum Disorder, be a client of Far Northern Regional Center (FNRC) or if your child is not a FNRC client but does have a diagnosis of ASD, the parents/guardians must be active SLATE members. Please contact your service coordinator at FNRC if your are interested in having your child attend the Get SET Program. 
Family/Guardian Information

By selecting yes, you agree to receive texts from Rowell Family Empowerment of Northern California at the mobile number you provided. Message and data rates may apply. Text STOP to unsubscribe from messages at any time. By subscribing, you agree to get text messages from Rowell about services we provide.

To view Rowell's Privacy Policy click the link below:

Child's Information

Child's Social/Behavioral Information

Health Care

Emergency Contact and authorized alternate pick up person #1

Emergency Contact and authorized alternate pick up person #2

Emergency Contact and authorized alternate pick up person #3

Fieldtrip Payment
$50.00 donation is requested once accepted into the program. Program Manager will reach out to you for instructions. 
Photo Release Authorization

Informed Consent and Acknowledgement