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Coffee & Conversation Interest Form: May 3, 2023
Join other parents in-person as we help you organize your child's records together!
¡Únase a otros padres en persona mientras los ayudamos a organizar los registros de su hijos!
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Email
*
Your email
Your Name / Su nombre:
*
Your answer
Email Address/Correo electronico
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Your answer
Best phone number to contact you / Numero de telefono para contactarlo.
*
Your answer
Which location of Coffee & Conversation will you be attending? ¿A qué oficina de Coffee & Conversation asistirás?
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San Fernando Valley
Santa Clarita Valley
Antelope Valley
How many will be attending?/¿Cuántos personas asistirán?
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Your answer
If you are a parent of a child/adult with a disability, do any of these apply:
Si es padre de un niño/adulto con una discapacidad, se aplica alguno de los siguientes:
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My child is Deaf or hard of hearing/Mi hijo es sordo o tiene dificultades auditivas
My child is blind or visually impaired/Mi hijo es ciego o con discapacidad visual
My child has a physical disability/Mi hijo tiene una discapacidad física
My child has an intellectual disability/Mi hijo tiene una discapacidad intelectual
Other/ Otro
Would you like someone from Family Focus Resource Center to contact you with additional resources at this time?
¿Le gustaría que alguien del Centro de Recursos de Enfoque Familiar se comunique con usted con recursos adicionales en este momento?
Yes
No
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