Special Needs: Chand Raat Celebration

Event Registration

Parent/Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Email Address *

Parent/Guardian Phone Number

Attendee Information

Number of Adults Attending *

Note: This event is for mothers and siblings only.

Number of Children Attending? *

Note: This event is only for children with special needs & siblings.

Please describe briefly the special need of your child? *

All information shared will be kept strictly confidential and used only to support your child’s needs during the event.

Are there any special accommodations your child will need?

Please list any dietary restrictions or allergies.

All information shared in this form will be kept strictly confidential and used only to support your child’s needs during the event.

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