Comox Valley Autism Social Sunday Registration
Please fill out the fields below.
Participant's Full Name
*
Participant's Date of Birth
*
date_range
Participant's Diagnosis
*
Participant's Support Needs
Participant Safety Concerns
Participant's Interests
What activities would you like to see?
Please attach a recent photo of Participant
*
Which Social Group(s) are you interested in?
*
2 - 5 Yrs Parent & Tot
5 - 9 Yrs Kids
9 - 14 Yrs Preteens & Teens
Parent/Caregiver's Full Name
*
Parent/Caregiver's Email Address
*
An adult is required on site for participant(s) under age 13 or those needing specialized support
*
Parent/Caregiver
Support Worker
Friend
Other
Over age 13
Adult remaining on site
Emergency Contact
*
Questions, concerns or accommodation requests.
Submit Registration Form