SibShops : What We Do : The Arc of Frederick County

Child's Name

First Name *

Last Name *

Date of Birth

Month

/

Day

/

Year

School (Required)

Grade (Required)

Does this child receive any special services (e.g. counseling, speech therapy, special education)?

Yes
No

If yes, please describe:

Which dates will your child be attending?

June 24
July 29
August 26
September 30
October 28
Winter Party (Date TBD)

Parent 1 Name

First Name *

Last Name *

Parent 2 Name

First Name

Last Name

Home Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Cell Phone Number (Required)

Email Address (Required)

Name of Sibling with Disability

First Name *

Last Name *

xjwrc183nwzy

Date of Birth

Month

/

Day

/

Year

Disability (Required)

School (Required)

What kind of related special education services (e.g., speech, occupational, or physical therapy, counseling, etc.) does this child receive? (Required)

If the child attending has any more siblings, please list their names, dates of birth, ages, and gender:

How did you hear about SibShops? (Required)

What are your reasons for enrolling your child in the SibShop program? (Required)

Do you have any concerns about enrolling your child in the SibShop?

Do you have any particular topics that you would like addressed during the SibShop?

Does your child have any food allergies or restrictions?

Please provide any other information that you feel will make this an enjoyable and educational experience for your child:

Do you agree?

Yes
No

Type your name as signature for the registration form and waiver set forth.

What We Do

SibShops

Online SibShops Registration Form

Privacy Policy

Terms & Conditions