TJC SPTA Org Presents Onboard for Adventure: A Flight Experience for Individuals with Autism

The Tyler Junior College Student Physical Therapist Assistant Organization Presents Onboard for Adventure: An Airport Experience for Individuals with Autism
We are excited to announce the Onboard for Adventure: An Airport Experience for Individuals with Autism event on Sunday, April 26th at Tyler Pounds Regional Airport from 11am-3pm, hosted by the Tyler Junior College Student Physical Therapist Assistant Organization in collaboration with TJC Apache Aeros and Neurodivergent Advocates of East Texas. This unique event is designed to help families of individuals with autism navigate the challenges of air travel in a safe, supportive, and low-pressure environment.

Airports can be overwhelming for many, especially for individuals on the autism spectrum, due to crowded spaces, sensory overload, and complex procedures. The Onboard for Adventure program offers a chance for participants to practice steps of the airport process, from check-in to walking down the jet bridge.

Event Details:
- Pre-Registration: Families will sign up in advance, mirroring booking an actual flight.
- Check-In: Families will check in and receive “boarding passes.”
- TSA Security: Participants will go through the TSA screening process with TSA staff and our volunteers available to guide and support them, giving feedback on appropriate modifications and behaviors as needed.
- Jet Bridge: Families will walk down the jet bridge simulating getting on the plane but turn around at the end of the bridge to return to the gate area and exit the airport.

This program is free of charge and designed to make air travel more accessible for children with autism and their families. It offers an opportunity to reduce the anxiety associated with flying by familiarizing participants with the airport and flight experience in a calm, understanding environment.

We look forward to seeing you on Saturday, April 26th, for this exciting and impactful event! More details, including arrival time and what to bring, to follow soon!
Participant's Full Legal Name (if no middle, place a -)*

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Participant's Date of Birth*

MonthDayYear
Date
Participant's Diagnosis*
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How many total will accompany the participant at the event? (limit of 6 per family, including participant, unless pre-arranged with event staff). If you have multiple participants, then you will need to fill out a separate form for each.*
Please list the full legal name(s)-First, Middle (if any), Last of any additional family members that will be in attendance. List Date of Birth AND Gender for each member. Anyone who is not on this list will NOT be included for a gate pass and will be required to stay in the check-in area.*
Primary Parent/Caregiver Full Legal Name - First, Middle (if any), Last*
Primary Parent/Caregiver & Participant Address*

Street Address

Street Address Line 2

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Postal / Zip Code
Primary Parent/Caregiver Cell phone (able to be contacted on event day if necessary)*
Please enter a valid phone number.Format: (000) 000-0000.
Primary Parent/Caregiver Email*
example@example.com
YesNoOther
YesNoOther
Participant is able to walk without any aide.Participant requires assistance for mobility. If yes, please also select Other below and explain what assistance/devices are required and if those devices will be with you.Participant uses a service animal at home and will be bringing the animal for this experience. An event coordinator will contact you for further details on requirements.Other
Aggression to Self/Others. If yes, please also select Other below and explain triggers and techniques to use.Propensity to Run/Escape/Elope. If yes, please also select Other below and explain triggers and techniques to use.Propensity to Have a Meltdown. If yes, please also select Other below and explain triggers and techniques to use.No other characteristics to report.Other
Agree
Participant Authorization for Medical Treatment and Emergency Contact

In the event that I cannot be reached to make arrangements for emergency medical attention, I authorize Tyler Pounds Airport and/or Tyler Junior College ("TJC") to take my child to a nearby medical facility for necessary treatment. I further consent and authorize any and all necessary treatment for my child at this medical facility and I accept all financial responsibility for such treatment and understand that Tyler Pounds and TJC will not be responsible for any such medical costs. In case of sickness or accident, I hereby authorize and consent to have medical personnel selected by Tyler Pounds and/or TJC to order and/or perform any medical attention or procedure deemed necessary. I understand and agree that Tyler Pounds and TJC and its employees will not, under any circumstances, be held responsible or liable in the event of accident or death arising out of or related to same medical attention and by signing below, I hereby release and agree to hold Tyler Pounds and TJC harmless for any claims or damages whatsoever related to any medical treatment or care provided to my child.
Participant's Insurance Company Name (Medical). If no insurance, place N/A in the box.*
Policy Number
Policy Holder's Name

First NameLast Name
Participant's Physician*
Physicians Phone Number*
Format: (000) 000-0000.
Emergency Contact Name (other than parent/caregiver in attendance, no one under the age of 18 is permitted to be listed)*

First NameLast Name
Emergency Contact Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Relation to Participant*
Emergency Contact Email*
example@example.com
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Participant Photo Consent and Release of Liability

The Image(s) may be used and released by Tyler Junior College and/or any other media outlet, membership or community organization and/or vendor toward the advancement of medical science, education (including lectures and presentations and educational materials), and/or publications (i.e. journals and books). The Image(s) may be used and released by Tyler Junior College for internal and external media use, publicity, promotion, advertising, marketing and/or fundraising for Tyler Junior College and/or any other purpose as stated above. The Image(s) may appear indefinitely on any online social media forum or other print and/or multimedia forum, and other participants on social and/or digital media channels may use the Image(s) beyond the control of Tyler Junior College. The Image(s) to be used as deemed appropriate by Tyler Junior College, including television, radio, broadcast, news releases, print, Internet websites, wikis and/or blogs, all social media platforms (i.e., Facebook, X, Instagram, etc, whether known or unknown, or any other means).
I hereby consent for myself and my child, who is a participant ("Participant"), to have photographs, video recordings, print and digital media and images, published and republished content, or any other content of the features or likeness made of me and/or Participant (the "Image(s)") by Tyler Junior College, its affiliates, any other media outlet(s), membership or community organizations and vendors providing services in relations hereto (collectively "Tyler Junior College") for the purpose ("Purpose") indicated below. I, on behalf of myself and Participant, consent to the use and release of the Images for any of the following Purposes, as indicated by my selections and digital signature:*

AgreeDisagree
Release of Liability

I, on behalf of myself and child: Release all rights to all Image(s) created and prepared, and release Tyler Junior College, its successors, assigns, officers, directors, employees, agents and/or other representatives from any claims, expenses (including attorneys' fees) and liabilities resulting from the production, authorized use or release of the Image(s); and Grant Tyler Junior College a non-exclusive, royalty-free, freely sub-licensable, perpetual and worldwide license to use the Image(s), including the right to copy, distribute, transmit, display, reproduce, republish, promote, sell, market, advertise, edit, translate and reformat and incorporate into a collective work or digital, print, and/or online media campaign (virtual or otherwise); and Grant to Tyler Junior College the right to grant permission to other people to publicly display the Image(s), including allowing others on digital, print and/or social media to display, post, repost, follow, comment, like, share, favorite, retweet or the like in relation to the Image(s) of my child. I understand that Tyler Junior College does not have the ability to intercept or otherwise remove the Image(s) from any web, print, digital or other media presence owned by another entity. I understand that the Image(s) of Participant is intended for public viewing, and I consent to the use of and release of Participant's identity. I will not be compensated by Tyler Junior College or any other person or entity for the use of the Image(s I have read and understand the statements contained in this Consent. I understand that Tyler Junior College will provide me a copy of the signed Consent upon request. I HEREBY FULLY RELEASE AND FOREVER DISCHARGE Tyler Junior College of and from any and all liability to me, my personal representatives, assigns, heirs and next of kin, for any and all claims, demands, or causes of action for personal injury, death, property damage or any other injury or damage of any nature arising directly or indirectly out of Participants attendance at or participation in the Onboard for Adventure. INCLUDING ANY DAMAGE, LOSS OR INJURY CAUSED BY ANY ACT OR OMISSION ON THE PART OF TYLER JUNIOR COLLEGE, INCLUDING ANY NEGLIGENT CONDUCT OF TYLER JUNIOR COLLEGE but excluding any gross negligence or willful misconduct of Tyler Junior College. IT IS MY EXPRESS INTENT THAT THE ABOVE RELEASE INCLUDES THE RELEASE BY ME OF TYLER JUNIOR COLLEGE FROM THE CONSEQUENCES OF TYLER JUNIOR COLLEGE'S OWN NEGLIGENCE. THE ONLY CIRCUMSTANCES UNDER WHICH MY RELEASE OF TYLER JUNIOR COLLEGE DOES NOT APPLY IS WITH RESPECT TO ANY OCCURRENCE RESULTING FROM THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF TYLER JUNIOR COLLEGE. I FURTHER AGREE TO INDEMNIFY, DEFEND, AND HOLD HARMLESS Tyler Junior College from and against any and all liability, damages, claims, lawsuits, costs (including court costs and attorney's fees), and actions of any kind or description for personal injury, death, property damage or any other injury or damage of any nature arising directly or indirectly out of Participant's attendance at or participation in the Onboard for Adventure, INCLUDING ANY DAMAGE, LOSS OF INJURY CAUSEDBY ANY ACT OR OMISSION ON THE PART OF TYLER JUNIOR COLLEGE, INCLUDING ANYNEGLIGENT CONDUCT OF TYLER JUNIOR COLLEGE but excluding any gross negligence or willful misconduct of Tyler Junior College. IT IS MY EXPRESS INTENT THAT THE ABOVE INDEMNITYINCLUDES INDEMNIFICATION BY ME OF TYLER JUNIOR COLLEGE FROM THE CONSEQUENCES OF TYLER JUNIOR COLLEGE'S OWN NEGLIGENCE. THE ONLY CIRCUMSTANCE UNDER WHICH MY OBLIGATION TO INDEMNIFY TYLER JUNIOR COLLEGE DOES NOT APPLY IS WITH RESPECT TO ANY OCCURRENCE RESULTING FROM THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF TYLER JUNIOR COLLEGE.THIS IS A LEGAL RELEASE OF LIABILITY AND CONSENT FORM. I HAVE READ THIS FORMCAREFULLY AND HAVE HAD ALL QUESTIONS ANSWERED BEFORE DIGITALLY SIGNING. BY DIGITALLY SIGNING THIS FORM, I HEREBY REPRESENT THAT I HAVE THE AUTHORITY TO PROVIDE CONSENT ON BEHALF OF THIS CHILD.
Agree
Parent/Legally Authorized Representative Name*

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Date*

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Time*

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The Tyler Junior College Student Physical Therapist Assistant Organization Presents Onboard for Adventure: An Airport Experience for Individuals with Autism

Participant Authorization for Medical Treatment and Emergency Contact

Participant Photo Consent and Release of Liability

Release of Liability