SUPPORT GROUP REGISTRATION FORM

Thanks for registering with FASD Connection Peel Support Group. All of your information will be kept confidential and will not be shared with anyone outside the support group. Feel free to contact us at fasdconnection@gmail.com if you have any questions.

    Your Name (required)
    Your Email (required)
    Your Phone Number (required)

    Your Address (required)
    Address Line 1
    Address Line 2
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    Your Child's Name (required)
    Your Child's Age (required)
    Does Your Child have an FAS Diagnosis
    YesNo

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    I have read and understand the Guidelines for FASD Connection Peel Support Group Meetings. By checking this box I will adhere to these guidelines at any meetings I attend.