Make and Take: Experience Books

Make and Take

Experience Books
Parent/Guardian Name:*

First NameLast Name
Email Address:*
example@example.com
Phone Number:
Please enter a valid phone number.
Home Address:*

Street Address

Street Address Line 2

CityProvince

Postal Code
Learner's Full Name:*
Learner's Age:*
Accommodation requirements

Large PrintBrailleElectronic FormatOther
If other, please specify:
*While we do our best to meet everyone's access needs and provide accommodations, this may not always be possible.
Participant's Dietary Information
Please indicate any dietary restrictions:
(food allergies/dietary restrictions)
Waiver for Participation:*

I acknowledge that I understand this is not a supervised event. APSEA staff will be present, but I am solely responsible for the safety of my family members.
Photography/ Video Consent:*

YesNo
Parent/Guardian Name:*
(used as your digital signature for this waiver)
Financial Support

Financial assistance for travel is available to families of learners who qualify for APSEA support.
Request financial support for travel expenses.

YesNo
Comments
Is there anything else you would like us to know?
Feedback
How did you hear about this program?*
If Other for how you found out about this program, please specify
Should be Empty:

Make and Take