Online Forms

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5. Exploring Abilities Registration Form
   Raising children with special needs may require extra resources to meet physical, intellectual, emotional, language, social, or behavioural needs. Connect with other parents who may share a similar experience to share resources, learn together, and build a community.
7. Session Details
   Date: TBD
   Time: TBD
   Location: Hinton Family Centre
9. Caregiver's First Name*
10. Caregiver's Last Name*
12. Child's First Name*
13. Child's Age*
15. Email Address*
16. Phone Number*
18. 1. Please list two topics that you would like to talk about in this setting:
20. 2. Do you need support accessing Zoom?

    1. Yes
    2. No
22. 3. Sessions may involve handouts. Do you have a way to print or view these documents during the group?

    1. Yes
    2. No
24. 4. Would you like to learn more about additional parent education and support services? *

    1. Yes
    2. No

    Your contact information will be used by the Caregiver Education Coordinator to contact you or share information with you
26. 5. Where do you live?*

    1. Hinton
    2. Edson
    3. Yellowhead County
    4. Other
28. 6. Additional Comments
    (please add any additional feedback here)
30. To participate in this online session, you must agree to protect privacy and confidentiality for yourself and other participants. *

    1. I AGREE I will not share my invitation or password with others
    2. I AGREE I will strive to view this session in a private area
    3. I AGREE I will not record, take screenshots of, or share this session
32. Thank You!
    Thank you for registering for the Exploring Abilities Group!
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field