Registration

Child's Name*
Child's Date of Birth*
Parent's/Caregiver's Name*
Age*
Gender*
Address*
Street Address Address Line 2 City State Post Code Country
Email*
Phone
Mobile
Diagnosis
Year of Diagnosis
Where did you hear about The Gold Foundation?
What are your main concerns in regards for your child
For example: social, educational, behavioural
Please describe any relevant family background information
eg: relationship between family members, medical issues
Other information
For example: likes/dislikes, other diagnosis
What type of programs would you/your child like to participate in?
Social skills training, Youth Group, Events, Parent Seminars
By registering with Gold Foundation, you are giving permission to go on our ‘registration list’ to receive emails and information about the Gold Foundation, upcoming programs and services.

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