Champions Club
We are really excited to have your child as part of our Champions Club and support your family however we can!
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CHILD INFORMATION
Child's First Name *
Child's Last Name *
Child's Nickname
Please let us know if your child responds better to a nickname
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Gender *
Child's Diagnosis *
e.g. Autism, Down Syndrome, Cerebral Palsy etc
Is your child Verbal or Non Verbal *
Does your child have an alternate way of communicating?
e.g. Communication app on Tablet, BSL, Makaton etc
Address
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