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Athlete Information Form

Welcome to the Adaptive Fitness & Movement Program. Our mission is to provide strategies for current and lifetime health and optimal development through fitness programs. Using the principles of Autism Fitness, this is where research and application meet.


Autism Fitness philosophy is to provide the physical foundation for strength, stability and motor planning in a way conducive to the athlete enjoying the activities. Combining a Best Practice approach from the fields of exercise science and Applied Behavior Analysis (ABA), Adaptive Fitness & Movement programs consider each athlete from three areas of functional ability: Physical, Adaptive, and Cognitive. These criteria allow for the development of an individual-specific program.


In order to develop and implement the optimal program for each athlete, we need some preliminary information. The more accurate the information provided, the more comprehensive and successful the program. This information can aid in trouble-shooting the short- and long-term goal setting. Please provide as accurate and truthful information as possible. No part of this form will be shared with any parties unless prior consent is given by a parent/guardian. 

Section i: Medical History

Does the athlete have any allergies including reactions to rubber, plastic, or ANY other materials?*

Section ii: Education Profile

Section iii: Education Profile continued

Section iv: Adaptive Profile 

Section V: Healthy Habits Profile

Section Vi: Adaptive Fitness & Movement Program Participation Agreement

I, ________________________________________________, give consent for _____________________________________________ my _________________________ (Relationship: child, ward/legal guardian,) To participate in a fitness/movement assessment session and/or adaptive group classes with Adaptive Fitness & Movement, LLC understanding that the initial assessment session and/or ongoing classes will last a duration of 30 minutes (individual) or 50 minutes (group classes) and I can observe the sessions at any point. I understand that the purpose of the assessment session is to evaluate Physical, Adapptive, and Cognitive skills in order to develop an individualized fitness/movement program that can also be implemented in the home, classroom, or other appropriate environment. I understand that the session(s) may involve vigorous physical activity and that physical prompting or graduated guidance, in which the instructor physically guides the athlete through the movement pattern, may be used in order to demonstrate or teach a particular skill. If I have any questions or concerns, I am aware that I can contact Lucille Lee at By signing below I am indicating I have read, understand, and agree with the guidelines.

Thanks for submitting!

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