Family Support Registration

The information parents provide below is for registry purposes only. Family support liaisons use the registry to make contact with families who have a child with Down syndrome and to help families connect with services in the community. Our goal is to assist families in developing a personalized support network that enables their child to integrate successfully in family, school and community life.



Personal Information:
My child’s name is
(First/Middle/Last):
Sex:    
DOB (YY/MM/DD):
School He/She attends:

Address of the School:

 

 

 

 

Phone # of school:
Current Grade:
My child lives with:

 

 

 

Language(s) spoken in the home:

Translator required:

 

 

 

Mother
First/Last Name:
Mailing address:  
Postal code:
Home #:
Work #:
Cell #:
Email:
Father
First/Last Name:
Mailing address:  
Postal code:
Home #:
Work #:
Cell #:
Email:
Guardian/Foster Family
First/Last Name:
Mailing address:  
Postal code:
Home #:
Work #:
Cell #:
Email:
My child’s brothers/sisters are:
Name:      
Sex: DOB (YY/MM/DD):
Name:    
Sex: DOB (YY/MM/DD):
Name:    
Sex: DOB (YY/MM/DD):
Name:

   
Sex: DOB (YY/MM/DD):
My family has the support of extended family close by:

 
This year my child has participated in the following community activities  
Art  
Church activities  
Dance  
Brownies or Guides or Scouts  
Music  
Sports

 
Other

 
This year my child is enrolled in the following programs for children with special needs:
Between Friends  
Disabled Skiing Association  
Special Olympics  
Challenger baseball  
Dolphins Swim Club  
Other

 
My family is presently a member in good standing of:
AACL (Alberta Association for Community Living)

 

 

The PREP Program
CDSS (Canadian Down Syndrome Society)
Ups and Downs
Other

My child/family is presently registered with:
Down Syndrome Clinic at ACH
Children’s Link
FSCD (Family Support for Children with Disabilities)
Early Intervention Programs (0-3yrs) Please name:

Respite Agency
Other

How can we help?
I would appreciate receiving information about services for:
My Child:   My family:
Education     Parent workshops  
In home support     Crisis support  
Health     Provincial/Federal Assistance  
Recreational     Family workshops (i.e.: sib-shops)  
Social     Family therapy/Marriage counselling  
Therapy     Respite services  
Other

    Other

 
At this time a Family Support Liaison can help me with the following:
Family Support at PREP offers workshops and parent networking groups to discuss concerns that are of common interest to families who have a child with Down syndrome (e.g. advocacy, acceptance, future planning, specific medical conditions). Are you interested in attending? If yes, please include your email address so that we can send you workshop calendars.
I suggest the following topic(s):
Name:

Email:

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