Teen SibShops Registration

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Teen SibShops Registration - November 6

An exciting workshop for brothers and sisters of children with special needs!

Monday , November 6, 2023 1-4 p.m. (in-person session).

The Sibshop workshops are for children in grades 7-8 who have siblings with special needs and who are enrolled in Fairfax County Public Schools.

This event will be in-person.

Providence Community Center

3001 Vaden Dr

Fairfax, VA 22031

Registration is free, however, donations are accepted to support the cost of future Sibshops: https://educatefairfax.app.neoncrm.com/donation.jsp?campaign=43&

Registration is required and limited, please register early. You will receive an email after registration to confirm your acceptance and participation.

Email *

Child's Full Name Participating (nickname too) *

Gender *

FCPS School child attends *

Grade *

Child's 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

Clear selection

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 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 November 6, 2023. 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). Further, I grant full permission to use any photographs of this program for the purpose of education and promotion of Sibshops. 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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