Day Program Contact Form | Doodlebug 2025

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DoodleBug Day Program Contact Information

First name(Required)

Last name(Required)

Birthday (Must be 18+)(Required)

Month

Day

Year

Disability(s)(Required)

Primary Guardian's Name(Required)

Guardian's Relationship to Participant(Required)

Address(Required)

City/State/Zip(Required)

Email(Required)

Phone(Required)

Primary language spoken at home

How did you hear about DoodleBug?

Can participant walk and climb stairs?(Required)

Can participant toilet on their own without assistance?(Required)

Can participant feed and eat on their own?(Required)

Does participant have behavioral outbursts?(Required)

Is the participant able to communicate verbally or with a device?(Required)

How many days are you interested in?(Required)

Which days of the week are you interested in?(Required)

For More Information

Contact Sarah Starke for enrollment information and a tour of the Workshop

630-995-1328
or

Address
314 S Main St
Wheaton, IL 60187

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