Choose from these membership types

INFORMATION ABOUT THE MEMBER

First and last name*

Your date of birth*

Main phone number (xxx-xxx-xxx)*

Communication language

Family type

Full address*

Home country (if other than Canada)

E-mail*

Date of arrival to Canada

Which programs do you want to use this year

This year you would like to get involved in

If you are employed, for which employer are you working

FIRST AND LAST NAME OF YOUR CHILD WITH A DISABILITY*

His/her date of birth*

Gender

INFORMATION ABOUT YOUR CHILD(REN) WITH A DISABILITY

Main diagnosis (choose from the drop-down menu)

With whom your child lives

Is your child attending school

If so, what is the name of the school attended

Does your young adult (over 21) attend a daytime activity

If so, specify witch daytime activity

FIRST AND LAST NAME OF YOUR 2e CHILD WITH A DISABILITY (if applicable)

His/her date of birth

Gender

Main diagnosis (choose from the drop-down menu)

With whom your child lives

Is your child attending school

If so, what is the name of the school attended

Does your young adult (over 21) attend a daytime activity

If so, specify witch daytime activity

I authorize Solidarity of Parents to use the information provided in this form for statistical and internal planning purposes

I authorize Solidarité de parents to take photos at various events (AGM, association activities) and to use them for any purpose the organization judges appropriate (website, Facebook, annual report, etc.).

In order to allow Solidarité de parents de personnes handicapées to pursue its mission and comply with the "Act respecting the protection of personal information in the private sector", we urge you to answer the following questions, sign this form and return it to Solidarité de parents de personnes handicapées