Discover CVI Registration
Please complete this registration form to be added to the Discover CVI group and attend the monthly meetings.
Child with CVI
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Child has
*
CVI only
CVI and Deaf/Hard of Hearing
Other
School District
*
Parent(s) Name
*
First Name
Last Name
First Name
Last Name
Parent Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you need accommodations during meetings?
*
ASL
Spanish Translation
Other (please specify)
I do not need any accommodations
Is there anything you’d like to share that would help us support you better in this group?
Submit
Should be Empty: