Name *

First Name

Last Name

Phone

We will not share your phone number with anyone.

(###)

###

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I am registering as a... *

Click all that apply.

Parent

Legal Guardian

Teacher / Educator

Community Organization Representative

Health or Social Services Professional

Extended-family member

Other

If your spouse or co-parent is also attending , please provide the following information (a separate registration is unnecessary).

First Name

Last Name

Phone

We will not share this phone number with anyone.

(###)

###

####

Will your child / children be attending? This is an inclusive event. Your child / children, neurodivergent and/or neurotypical, are welcome to attend with you. If you answer "Yes" or "Maybe", please provide each child's information below. *

YES

NO

MAYBE

Child 1 Information

First Name

Last Name

Child 2 Information

First Name

Last Name

Child 3 Information

First Name

Last Name

Event Photos - Consent. This is a public event and photos will be taken and shared on the web, social media and in follow-up documentation. *

YES - individual (person who registered)

NO -individual (person who registered)

YES spouse or co-parent

NO spouse or co-parent

YES - child(ren

NO - child(ren)

What do you hope to learn from this event? *

How to access autism-related services (general)

How to access autism-related services in English

Users' Rights

Meet other autism families in the community

Other

Are you interested in receiving more information about CASE-MCQ's activities, events or information that may be of interest to the English-speaking community of MCQ? *

YES

NO

How did you hear about this event?

Email

Facebook

A friend

A family member

Other