Family Support Form

My family is seeking information and support. Please contact us.

* Indicates required field

Guardian's Name *

First

Last

Email *

Phone Number *

Number to Text *

Preferred method of contact *

Email Phone call Text Messaging Other, please specify below

Other method of contact *

Home Mailing Address *

City/Town *

Postal Code *

Province *

Child's Name *

First

Last

Child's Age *

Does your child attend school? *

No Yes, we home school Yes, my child attends public school (please provide school name in comments) Yes, my child attends private school (please provide school name in comments)

School name *

Please provide details about your family needs and the type of support your child requires *

Other way I learned about CLASS? *

Submit