Event Registration Form/Registro al Evento

Number of Attendees / Number asistiendo First Name/ Nombre Last Name/ Apellido Ethnic/Racial Identity/Identidad étnica/racial: African American/Black American Indian/Alaskan Native Asian Caucasian/White Hawaiian/Pacific Islander Hispanic/Latino Multiracial Russian/East European Other Prefer not to disclose Unknown 1st Child's Ethnic/Racial Identity/Identidad étnica/racial del primer hijo: African American/Black American Indian/Alaskan Native Asian Caucasian/White Hawaiian/Pacific Islander Hispanic/Latino Mutiracial Russian/East European Other 2nd Child's Ethnic/Racial Identity/Identidad Etnica o Racial del segundo hijo African American/Black American Indian/Alaskan Native Asian Caucasian/White Hawaiin/Pacific Islander Hispanic/Latino Mutiracial Russian/East European Other 1st Child's Name/Nombre del primer hijo: 1st Child's Primary Disability Diagnosis/ Diagnóstico de discapacidad primaria del primer niño ADD/ADHD Autism Spectrum Disorders Autism/Down Syndrome Autism/Cerebral Palsy Autism/ Emotional - Behavioral Disability Autism/Intellectual Disability Blind Visual Impairment Cerebral Palsy Communication Disorders/Speech and Language Impairments Deaf/Blindness Deaf/Hearing Impairment Developmental Disability Down Syndrome Dyslexia Emotional - Behavioral Disabilities Fetal Alcohol Syndrome Fragile X Syndrome Intelectual Disability Learning Disability Medical Conditions/Special Health Needs Mental Health Multiple Disabilities Physical Disabilities Post Traumatic Stress Disorder Rare Disorders Rett Syndrome Seizure Disorder/Epilepsy Sensory Processing Disorder Tourette Syndrome Traumatic Brain Injury Unknown or not Provided No Disability 2nd Child's Name/Nombre del Segundo hijo: 2nd Child's Primary Disability Diagnosis/ Diagnostico de Discapacidad Primaria del segundo hijo: ADD/ADHD Autism Spectrum Disorders Autism/Cerebral Palsy Autism/Down Syndrome Autism/ Emotional - Behavioral Disability Autism/Intellectual Disability Blind/Visual Impairment Cerebral Palsy Communication Disorders/Speech and Language Impairments Deaf/Blindness Deaf/Hearing Impairment Developmental Disability Down Syndrome Dyslexia Emotional - Behavioral Disabilities Fetal Alcohol Syndrome Fragile X Syndrome Intellectual Disabilty Learning Disability Medical Conditions/Special Health Needs Mental Health Multiple Disabilities Physical Disabilities Post Traumatic Stress Disorder No Disability Rare Disorders Rett Syndrome Seizure Disorder/Epilepsy Sensory Processing Disorder Tourette Syndrome Traumatic Brain Injury Unknown or not Provided Captcha