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The Special Friends Network Questionnaire and Member Information Form
Hello Friends. Please take the time to fill out this form. Help me make The SFN all that we want it to be!
Parent or Caregiver Name and contact information: Please include email address. *
Your answer
Emergency Contact phone number (while Participants are at events) *
Your answer
Participant Name (first and last) *
Your answer
Participant Age and Birthdate *
Your answer
Would you like to take part in our Birthday Club? The SFN will acknowledge our Members birthday. We may mail a birthday card, send a small gift or Celebrate their birthday at an event. We will post upcoming birthdays on the Facebook page...you may receive cards from other members :) If you DO want to participate, please include your mailing address with the Contact info. above. *
Please tell us more about you (the participant). Include any Special Needs or Medical conditions you fell we should know about.
Your answer
If the participant becomes anxious, upset or has any behavioural issues, How can we best comfort or redirect them?
Your answer
Do you have any allergies or dietary restrictions? (If Yes, please inform us at each event and always send an epi-pen) *
Your answer
What kind of events do you most enjoy? Include any activities you would like to see planned for future SFN events. *
Your answer
What kind of activities/events do you NOT like or would not choose to attend?
Your answer
Is cost a factor in your participation in any event? *
Your answer
Would you be interested in attending a Parent/Guardian discussion, where topics would include: Your child/wards future, Adulthood in the Special Needs Community. *
Please share any questions, concerns, suggestions, ideas you may have. What would you like to see available for your SN family and friends? Not just through The SFN but in the community, society, school etc. What needs does your family have that are not being met? What would make your life easier, or the lives of your loved ones? *
Your answer
Additional comments or information you would like to share:
Your answer
Do you give permission for The Special Friends Network to use photographs taken at events for use ONLY on our Facebook page and/or Website? *
I/we understand that all participants in The SFN events and activities, are supervised in a group setting and have access to some guidance from Volunteers HOWEVER all participants are expected to be independent enough to participate without the need for one on one assistance/support. If an individual does need personal support for personal hygiene/care, SAFETY or to fully engage in an event without causing harm or distress to themselves or other attendees, the participant MUST attend with a personal support worker or family member. *
Do you agree to the Following for any and all future SFN events? We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him (her) to participate fully in Events and activities planned and held by The Special Friends Network, and hereby release and forever discharge The Special Friends Network and any of its associates or volunteers from any and all responsibilities and liability claims. *
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