Inscription 1 activité enfant 3-12

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Person filling out the form

First Name of the person filling this form

Last Name of the person filling this form

Email

To which e-mail address should we send the service confirmation?

Person in charge of registration phone number

Participant 1 Information

First name

Last name

Date of birth

Participant 2 Information

Please complete this section if you are registering :
1- other autistic children

and/or
2- siblings, if you are applying for activities that are also opened to siblings.

Without this information, we will assume that the application only includes your child with autism and we will not have the resources to accommodate other children in the family.

First name (participant 2)

Date of birth (participant 2)

Participant 3 Information

First name (participant 3)

Date of birth (participant 3)

Participant 4 Information

First name (participant 4)

Date of birth (participant 4)

If one or more participants are 12 years old, please specify the type of school they attend (elementary or secondary).

If necessary, give us some details as per your answer.

I want to register my child for Evening Respite offered on Friday

Respite is offered

Schedule: Friday evening from 5 pm to 9 pm
Frequency: 3 times during the session

Period of time: From January 21st to May 16th, 2026
Offered to families of children with autism aged 3 to 12, all profiles combined, as well as their siblings
Cost: $15/evening

Place: Trait d’Union, 109 Wright st

Child Friday evening respite

Yes, it's my 1st choice.

Yes, it's my 2d choice.

No

I want to register my child for Day Respite offered on Saturday

Respite is offered

Schedule: Saturday from Noon to 4 pm
Frequency: 3 times during the session
Period of time: From January 21st to May 16th, 2026
Open to all children, regardless of profiles witout siblings.
Cost: $15/day
Place: Trait d’Union, 109 Wright st

Child Saturday Respite options

Yes, it's my 1st choice.

Yes, it's my 2d choice.

No

I would like to register my child for the following activities

Yes, I confirm the registration for March 5th.

March 5th - Outdoor Winter Activity
A parent may accompany their child and the equipment will be provided to them.
Not opened to neurotypical siblings.

Yes, I confirm the registration for March 28th.

March 28th - Afternoon for neurotypical siblings only.

Comment

Please indicate if necessary:

Any dates when your child is unavailable.
Any additional information you would like to share with the team.

Comment

Contact us

Registration

Person filling out the form

Participant 1 Information

Participant 2 Information

Participant 3 Information

Participant 4 Information

If one or more participants are 12 years old, please specify the type of school they attend (elementary or secondary).

I want to register my child for Evening Respite offered on Friday

I want to register my child for Day Respite offered on Saturday

I would like to register my child for the following activities

Comment