Name of Person Receiving LAF Service *

First Name

Last Name

Signature *

By providing my electronic signature below I allow the Lowcountry Autism Foundation to use the above information as well as a picture of me/my child on various media accounts including the website, monthly newsletters and social media.

First Name

Last Name

LAF services received *

Please check all services you have received from LAF

Family Support Services

Swim Lessons

Educational Support

Art Therapy

Parent Training and Support Group

Parent's Night Out

LAF on the Wild Side

WholeheARTed + Om

Video Testimonial

Please check below if you would be willing to submit a short video testimonial and one of our LAF team members will contact you with more information.

I am interested in submitting a video testimonial, please contact me.