Parent Support Day Aug/Sept Application Form

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* 1. email address:

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* 2. Telephone number:

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* 3. Your name:

First name:

Surname:

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* 4. Child's name:

First name:

Surname:

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* 5. Child's age:

Under 1

1-2

3-4

5-6

7-8

9 or older

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* 6. Does your child have a diagnosis of autism?

Yes

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* 7. Is your child in:

Nursery (Mainstream)

Nursery (Special Needs)

School (Mainstream)

School (Special Needs)

At home

Other (please specify)

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* 8. Do you have any particular question?

I want to find out more about ABA (Applied Behaviour Analysis)

I want to find out more about what support I can get from the Special Educational Needs system

I want help getting a diagnosis

I have another question I need help with (specify below)

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* 9. I can attend on 29th August or 14th September in Bracknell, Berkshire

14th September

I would like to come but not on this date

I do not want to attend

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* 10. If Yes, how many parents would want to attend

One

Two

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* 11. If No, I may be able to attend on a date in:

October

November

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* 12. I will come by:

Public Transport

Car