Booking F2F: Registration Form

Your Name

Email (required)

Telephone

School / Company / Group

Street Address

City / Municipality

Province / State

Postal/Zip Code

Presentations of Interest:
Puppet Presentations
Simulation Game Presentations
“What Does it Feel Like to Have ASD” Presentations (grades 10-12 and adults)

Date of Interest (first choice) Day * ---- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month ------ January February March April May June July August September October November December

Date of Interest (second choice) Day * ---- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month ------ January February March April May June July August September October November December

* Please note that Presentations are offered on Tuesdays, Wednesdays and Thursdays.

Number of Classes Select -------- 1 2 3 4 5 6 7 8 9 10

Grades of Classes Participating:

Approximate Number of Children Select -------- 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 250 260 270 280 290 300

Recess Time: StartEnd

Lunch Time: StartEnd

Dismissal Time:

Comments and Questions: