ID/A Services Waitlist

Thank you for your interest in attending an Intake and Registration Workshop for Intellectual Disabilities and Autism Services.

The following waitlist is for the August 25th date. If the slots are full, or if you cannot attend the spot available, please complete the form below to be added to the waitlist. If a spot becomes available, we will contact you using the information you provide.

This waitlist is also used to share your interest in if additional workshops become available. If August 25th does not work for you, please mark off "inform me of additional date" below.

Child's Name

First NameLast Name

Child's Age

Child's Disability

Parent/Caregiver's Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please mark which time slots you'd like to be added to the waiting list for the August 25th session.