Sibshop Registration

This event provides siblings of children with special needs an opportunity for peer support in a relaxed, recreational setting. During this time we will enjoy games, informational activities, food, and fun!

December 7, 2023
5:30 - 7:30 PM

Air Madness
310 Industrial Road
Harrisburg, SD

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* Parent/ Guardian Contact Information:

First Name:

Last Name:

Address:

City/Town

State

Zip Code

Email Address:

Phone Number:

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* How do you identify your ethnicity/race?

Other (please specify)

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* Please indicate your primary language:

English

Spanish

Other (please specify)

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* Child One: Please provide the following information on the first child you are registering.

First Name:

Last Name:

Age:

Birth Date:

Any special needs/allergies/etc:

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* Child Two: Please provide the following information on the second child you are registering.

First Name:

Last Name

Age:

Birth Date:

Any special needs/allergies/etc:

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* Child Three: Please provide the following information on the third child you are registering.

Child Three First Name:

Child Three Last Name:

Age:

Birth Date:

Any special needs/allergies/etc:

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* If you have questions or comments, please leave in the box below or contact South Dakota Parent Connection at (800) 640-4553 or by email at sdpc@sdparent.org.