Inscription activités enfant

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Administration

Category and profile of participant

Fréquentera enfant (préscolaire et école primaire)

General information

First name

Last name

Date of birth

Person filling out the registration 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?

School aged children services

Please choose the activities you would like to enroll your child in.
If you are interested in both activities, put them in order of priority so that our team can have this information on hand when sharing places. Depending on the number of requests received, we may only be able to offer you one type of service.

Programme structuré du samedi = Saturday Structured program

Répit de soirée = Evening Respite

Activités - enfants - 1

Activities - youngsters - 2

Dates

Actitivies will be offered on the following days:

Activities	Dates
Structured program	January 20 and 27 February 3, 17 and 24 March 2, 16 and 23 April 13 and 20 May 11, 18 and 25
Evening Respite	January 26 February 2, 9, 16 and 23 March 1, 15, 22 April 5, 12, 19 and 26 May 3, 10, 17, 24 and 31 June 7

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

Evening Respite - Sibbling information

If you have indicated that you are interested in the evening respite activity, please tell us the first name and date of birth of the brothers and sisters who will accompany your autistic child during this evening.

If you have indicated an interest in this service and this box remains empty, we will consider that the request only includes your autistic child and we will not have resources to accommodate other children in the family.

If you have not requested this service, go to the next question

Sibbling's first name and Date of Birth

Commentaire

Commentaire ou informations supplémentaires que vous souhaitez communiquer à l'équipe.

Comment

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Registration