WAITING LIST FOR SIBSHOPS - An exciting workshop for brothers and sisters of children with special needs!
PLEASE COMPLETE THIS FORM TO BE INCLUDED ON THE WAITING LIST FOR THIS SIBSHOP WORKSHOP! This Sibshop workshop is for 8 to 13 year-old siblings of children with special needs enrolled in Fairfax County Public Schools to meet other siblings in a fun, recreational setting; celebrate the many contributions made by brothers and sisters of children with special needs; share sibling experiences and receive peer support; play games and more!

Due to limited availability, you will be contacted by April 20th if your child has been selected to attend the Sibshop workshop. If selected to participate, please plan for your child to wear sneakers and have fun! A pizza lunch will be served.

SATURDAY, May 5, 2018
10:00 a.m. - 2:00 p.m.

Key Middle School
6402 Franconia Road
Springfield, VA

When you bring your child to the Sibshop workshop, you will be asked to complete a permission form and waiver in order for your child to participate, as well as permission for use of photographs or recordings.

For more information, call 703-204-3941.

Child's Name *
The sibling of the child with special needs who will attend the Sibshop workshop
Your answer
Child's Age *
Your answer
School that the child attends *
Your answer
Child's Grade *
Your answer
Child's Gender *
Your answer
Does your child have any special needs or allergies/restrictions *
Please explain.
Your answer
What are your reasons for enrolling your child in the Sibshop workshop? *
Your answer
Do you have any concerns about enrolling your child in the Sibshop workshop? *
Your answer
Do you have any particular topics that you would like to have addressed during the Sibshop workshop? *
Your answer
Please provide any other information that you feel will make this an enjoyable and educational experience for your child. *
Your answer
Parent's Name *
Your answer
Home address *
Your answer
Home phone number *
Your answer
Cell phone number *
Where we can reach you during the Sibshop workshop
Your answer
Email address *
Your answer
Emergency Contact Information *
Include name, phone number and relationship to child attending the Sibshop program
Your answer
Name of brother or sister with special needs *
Your answer
Age of brother or sister with special needs *
Your answer
Gender of brother or sister with special needs *
Your answer
School that brother or sister with special needs attends *
Your answer
Nature of the disability or illness of the brother or sister with special needs *
Your answer
Related special education services that the brother or sister with special needs receives *
For example: speech, occupational or physical therapy, counseling, etc.
Your answer
Other siblings in the family *
Please include name, age and gender
Your answer
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