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Resource Conference Registration Form

If you do not receive a confirmation email in 3 business days, DO NOT fill out this form again. Instead, please call Support for Families at 415.920.5040 or email resourcefair@supportforfamilies.org to check that you are registered.

*Required Fields
* First Name: * Last Name:
* Phone    
* Email:
  Address:
  City
  State:
* Zip Code:    
 
Gender:      
 
Ethnicity:
 
Date of Birth:   ,  
 
What language do you most speak at home?
 
 
Interpretation Needs?
Spanish    
Cantonese    
American Sign Language    
       
* Please tell us about yourself: (please select at least one)
I am a parent    
I am a student    
I am a professional :
 
 
Your Agency:
 
       
* How did you hear about this conference?
   
 
       

Food Preference*:      

*(NOTE: This is for our food planning purposes only. Lunch is comprised of pre-made deli sandwiches, chips, a drink and a cookie. While the sandwiches reflect a range of vegetarian and non-vegetarian options, all of the sandwiches may contain nuts/seeds. We cannot guarantee individual food preferences OR accomodate medical dietary restrictions, so please bring your own lunch if you cannot eat the food provided.)


Comments or special accommodations:
    
 
Please tell us about your child:
(This is optional, however it helps our funders better understand the work we do.)
  Child Disability/Special Health Need:  
 
 
 
  Child's Gender: Female   Male  
  Date of Birth:   ,    
  Ethnicity:  
     

 

Child care is available free of charge for families and professionals attending the conference
(space is extremely limited)

  Will you need childcare? Yes No
 
  If you have a cell phone, please provide us with that number here:  
 

Cellphone number:
If you do not have a cell phone, please check this box. 

Your cell phone number will only be used to contact you should an emergency arise with your child. It will not be used for any other purposes.

Please note: Your workshop selections are automatically noted on our childcare registration form.  If we are unable to reach you via cell phone, or if you do not have a cell phone, we will send a staff person to the room where the workshop is being held to locate you.

Support for Families is not a licensed child care facility, and does not provide licensed child care services.  Care Giving at SFCD is provided only for parents whose children are on-site; and at all times parents remain at the same site as their children.

***IMPORTANT - NEW CHILDCARE POLICY THIS YEAR: Due to childcare no-shows, this year we will call all registrants who have registered for childcare on Friday February 27 to confirm their childcare registration(s). If you do not call back to confirm with us by Friday March 6, we will release your childcare registration to allow families off the waitlist to secure childcare. Thank you for your cooperation!






Last updated • January 20, 2015
Problems or suggestions about this form? Email: tech@supportforfamilies.org

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415-282-7494
1663 Mission St. 7th Floor, San Francisco, CA 94103

@ Support for Families Warmline
415-920-5040
1663 Mission St. 7th Floor, San Francisco, CA 94103

©2011 Support for Families of Children with Disabilities

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