SibShops Registration

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SibShops Registration - January 20

Email *

Child's Full Name Participating (nickname too) *

Gender *

FCPS School child attends *

Grade *

Child's School ID

Sibling's Disability *

Parent email address *

Parent(s) Name *

Home address: *

Home phone: *

Cell phone/ number where we can reach you during the Sibshop Workshop: *

Emergency Contact Name: *

Emergency Contact Phone Number: *

Does your child have any special needs or allergies/health conditions that might affect participation? *

yes

If you said yes, please explain below.

Has your child attended a Sibshop before? *

yes

Was this Sibshop held by FCPS? *

yes

What do you hope your child will gain from attending this Sibshop Session? Are there any particular topics you hope will be addressed? *

Preferred Communication Language (If not English)?

Are you open to receiving further information on sibling issues from the FCPS Sibshop Team?

yes

Are you open to us adding your contact information to our Sibshop Directory (sharing your contact information with parents of other participants)?

yes

If there is any info you would like EXCLUDED from the directory (child’s name, grade, school, parent email, parent phone), note it here. If nothing is noted, all above mentioned info will be included.

I hereby give my child permission to participate in the Sibshop workshop to be held on January 20, 2024. I agree to hold Fairfax County Public Schools, their officers, employees, and volunteers, harmless for any and all liability incurred from bodily injury and/or property damage as a result of my child’s participation. I also agree to hold Fairfax County Neighborhood and Community Services, its officers, employees and volunteers harmless for any and all liability incurred from bodily injury and/or property damage as a result of my child’s participation. I also agree to hold the above listed harmless for any failures of third-party technology that result in a loss of data or breach of confidentiality, as well that parents can be contacted by Sibshop coordinators (FCPS social workers) by phone calls, e-mails, and other electronic means (e.g., app platforms such as Talking Points that allows for texting). Please check the box below if you consent.

Yes, I agree to give consent for my child to participate in the Sibshops workshop according to the above terms. _____

Still and moving images are taken during Sibshops for the purpose of education and promotion of Sibshops. Check the appropriate box below.

Yes, I give consent for my child to participate in digital media during the Sibshops workshop.

No, I do not give consent for my child to participate in digital media during the Sibshops workshop

e-signature (typing your name here indicates that you are agreeing to the above and signing this document as if it were your standard signature)

Date

YYYY

A copy of your responses will be emailed to the address you provided.

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