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Expression of interest for Hanen More Than Words program
Hanen More Than Words Program
Expression of Interest
Expression of interest for Hanen More Than Words program
Child's name
*
Child's age
*
Does the child have a diagnosis of autism or other social communication difficulties?
*
Yes
No
Add more details (optional)
Parent/carer name
*
Email
*
Phone number
*
Availability: Please choose one of the options below
*
I am available for the next online program commencing Thursday 23rd June.
I am not available for this program but I would like to register my interest in future programs.
I am available for parent sessions on:
Monday
Tuesday
Wednesday
Thursday
Friday
Add more details (optional)
How did you hear about the program?
*
My keyworker at Lifestart
Email from Lifestart
Social media
Word of mouth (please specify below)
If word of mouth, please specify:
Next steps: Please choose one of the options below
*
I would like to know more about the program
I have all the information I need and am ready to sign up
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