Event Registration Form/Registro al Evento

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How to Get and Use a CommCard Training

03/20/2025 05:00 PM - 07:00 PM PT

Admission

Free

Location

Central Oregon Collective
62070 SE 27th St.
Bend, OR 97701

Both trainings are required for self-advocates to receive their CommCard. Please plan on attending 3-20-2025 and 4-10-2025. Self-Advocates are encouraged to bring a support person with them to support them during this training.

CONTACT INFORMATION/ INFORMACIÓN DE CONTACTO:

Number of Attendees / Number asistiendo Company if applicable/ Compañía si aplica First Name/ Nombre Last Name/ Apellido Email /Correo electrónico Primary Phone/Teléfono Address/Domicilio City/ Ciudad Zip / Código Postal - County / Condado: (eg: Crook, Deschutes, Grant, Harney, Jefferson, Klamath, Lake, Wheeler) State/ Estado Primary Role/ Su rol primario Secondary Role/Rol Secundario: Primary Language/ Lenguaje

SCHOOL DISTRICT/ DISTRITO ESCOLAR:

Crook County/Condado Crook: Deschutes County/Condado Deschutes: Grant County/Condado Grant: Harney County/Condado Harney: Jefferson County/Condado Jefferson: Klamath County/Condado Klamath: Lake County/Condado Lake: Wheeler County/Condado Wheeler: Other/ Otro

DEMOGRAPHIC INFORMATION / INFORMACIÓN DEMOGRÁFICA:

While the demographic information that you provide is voluntary, the funding sources that support CODSN's work request data periodically./ Aunque la información demográfica que usted proporciona es voluntaria, las agencias que apoyan el trabajo de CODSN piden datos periódicamente.

Ethnic/Racial Identity/Identidad Etnica o Racial 1st Child's Ethnic/Racial Identity/Identidad étnica/racial del primer hijo: 2nd Child's Ethnic/Racial Identity/Identidad Etnica o Racial del segundo hijo

INFORMATION ABOUT YOUR CHILD/CHILDREN WITH A DISABILITY/ INFORMACION ACERCA DE SU HIJO(A) CON DISCAPACIDAD:

Please share more information so that we are able to help you in the future./ Por favor, comparta más información para que podamos ayudarle en el futuro.

1st Child's Name/Nombre del primer hijo: 1st Child's Year of Birth/Fecha de nacimiento del primer hijo: 1st Child's Primary Disability Diagnosis/Diagnóstico primario de discapacidad del primer niño: 2nd Child's Name/Nombre del Segundo hijo: 2nd Child's Year of Birth/ Fecha de nacimiento del segundo hijo: 2nd Child's Primary Disability Diagnosis/ Diagnostico de Discapacidad Primaria del segundo hijo: Child/Children With A Disability is/Are A Recipient Of/El/los niño/s con discapacidad es/son beneficiario/s de

SUPPORTS/ INTERPRETATION/ APOYOS/ INTERPRETACIÓN

If you need accommodations please list them here. Interpretation Support Needed In Spanish / Necesito Servicios de Interpretación

RELEASES/ LANZAMIENTOS:

Photo/video Release - I/We hereby give consent to Central Oregon Disability Support Network (CODSN ) and all programs under CODSN to photograph or Video our child/self to educate others about the programs and services offered by CODSN. Among the uses contemplated are illustration of articles in newsletters, TV news articles, in profiles that contributors receive, in brochures, to illustrate services discussed on the website, in displays at community fairs, to publicize local programs, to make professional presentations, and to publicize the equipment and teaching methods used. In giving approval, I/we understand it is without consideration of compensation of any kind, and CODSN is released from any claims or liability. /Publicación de fotografías: por la presente, yo / nosotros damos nuestro consentimiento a la Red de Apoyo para Discapacidades del Centro de Oregon (CODSN) y todos los programas bajo CODSN para fotografiar a nuestra familia / niño / a mi para educar a otros sobre los programas y servicios ofre

Yes/Sí

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