Support Group Registration

Support Group for Parents of Black Children with Disabilities

Monthly

6:00-7:30pm

Online via Zoom

Question Title

1. Registration (Required.)

First & Last Name *

Address *

Address 2

City *

State *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

2. Please indicate whether you are one of the following: (Required.)

Parent/Guardian

Caregiver

Advocate/Professional

Other/Otro (please specify)

Question Title

3. Please describe your race/ethnicity. (Required.)

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Two or more races

Decline to answer/Negarse a responder

Other/Otro (please specify)

Question Title

4. Please select your child's disabilities. (Required.)

ADD/ADHD

Autism Spectrum Disorder

Deaf-Blindness

Developmental Delay

Emotional Disturbance

Gifted

Hearing Imp. (Including Deafness)

Intellectual Disability

Multiple Disablities

No IDEA Disability

Orthopedic Impairment (Physical)

Other Health Impairment

Specific Learning Disability

Speech Language Impairment

Suspected/Undiagnosed

Traumatic Brain Injury

Visual Impairment (including blindness)

Other (please specify)

Support Group Registration

Support Group for Parents of Black Children with Disabilities

Question Title

1. Registration (Required.)

Question Title

2. Please indicate whether you are one of the following: (Required.)

Question Title

3. Please describe your race/ethnicity. (Required.)

Question Title

4. Please select your child's disabilities. (Required.)

Question Title

5. What is your child/children's age(s)? (Required.)

Question Title

6. What are you hoping to get out of this support group?

Question Title

7. Do you require any accommodations? If so, please specify.

Question Title

8. How did you hear about Show and Tell?

Support Group Registration

Support Group for Parents of Black Children with Disabilities

Question Title

* 1. Registration (Required.)

Question Title

* 2. Please indicate whether you are one of the following: (Required.)

Question Title

* 3. Please describe your race/ethnicity. (Required.)

Question Title

* 4. Please select your child's disabilities. (Required.)

Question Title

* 5. What is your child/children's age(s)? (Required.)

Question Title

* 6. What are you hoping to get out of this support group?

Question Title

* 7. Do you require any accommodations? If so, please specify.

Question Title

* 8. How did you hear about Show and Tell?

1. Registration (Required.)

2. Please indicate whether you are one of the following: (Required.)

3. Please describe your race/ethnicity. (Required.)

4. Please select your child's disabilities. (Required.)

5. What is your child/children's age(s)? (Required.)

6. What are you hoping to get out of this support group?

7. Do you require any accommodations? If so, please specify.

8. How did you hear about Show and Tell?