SibClub Registration Form
Siblings of individuals with special needs often have the longest lasting relationship with that person - do what you can to make sure it's a positive one! During SibClub, siblings have the opportunity to participate in fun activities related to a variety of topics with other kids who "get it". Our first three sessions in this series are in conjunction with the Greenboro Police Department's therapy dog program!

Register your child and receive more information by filling out the form below. Contact sarah@fsncc.org if you have any questions or if you prefer to fill out the form in person.


Please note that by submitting this form you agree to the following:
I assume all risk and hazards of the conduct of the program and release from responsibility any person providing transportation to and from activities. In case of injury, I hereby waive all claims or legal actions, financial, or otherwise against Family Support Network of Central Carolina, their elected officials and employees, the organizers, sponsors, supervisors or any volunteer connected with the program. In absence of a signature, participation in the program shall constitute and acceptance of conditions set forth in the release. I grant full permission to use photographs, videotapes, motion pictures, recordings or any other record of this program for educational/promotional purposes.

Email address *
Parent's Name (First & Last): *
Your answer
Parent's Phone Number: *
Your answer
Address: *
Your answer
Participant's Name (First & Last): *
Your answer
Participant's Date of Birth: *
MM
/
DD
/
YYYY
Participant's School: *
Your answer
What grade is the participant in? *
Your answer
Provide a few details about their sibling (Name, Age, Diagnosis, etc.): *
Your answer
Why are you registering your child for SibClub? *
Your answer
How do you prefer to receive reminders about SibClub meetings? *
How did you hear about SibClub?
Your answer
Does your child have any food allergies, dietary restrictions, or other special care instructions that we should be aware of? *
Your answer
Do you have any questions or concerns?
Your answer
A copy of your responses will be emailed to the address you provided.
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