RSVP 1 — Families Matter Co-op

The Reconnect Series Registration

Independent Living - Wednesday, June 21 from 6:30 to 8:00pm at Ottawa Independent Living Resource Centre (214 Montreal Rd., Suite 401)

Name

First Name

Last Name

Total number of people attending?

Which best describes your family?

If your family member who identifies with a developmental or intellectual disability would like to sign up for the social activity (led by OILRC ) please complete the following field to be added to our waiting list.

Name

First Name

Last Name

Age

Allergies

I confirm that the above named participant

If your loved one requires any assistance with toileting or behaviour, they are required to be accompanied by their own support staff to register for the activity.

does not require one-to-one support

requires one-to-one support and will come with a support person/worker

Is there a particular art activity you'd like us to consider including?

Please provide additional information that will help ensure a positive time for the above named participant?

Emergency contact information (name and phone number)