Form

Address

Parent 's E-mail Address
Would you like to be notified by email of other special events hosted by the CEC?

Yes No
Is this your child's first time at a Super Sib Day Event?

Yes No
Emergency Contact
Emergency Contact*
First Name Last Name
Emergency Contact Phone Number
- Area Code Phone Number

Emergency Contact Address

Brother/Sister with Special Needs
Name of Sibling
First Name Last Name
Birth Date of Sibling
Month Day Year
Nature of Disability or Illness
What kinds of therapy services (e.g. speech, physical therapy, counselling, etc.) does this child receive?
Additional Information
What are your reasons for enrolling your child in Super Sib Day?
How did you hear about this event? (Please choose from the drop-down menu to the right).*
Comments (Please list any food allergies/restrictions or any other comments that the staff of this event may find useful regarding your child).
Should be Empty:

Super Sib Day