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?*

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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:

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How did you hear about the program?*

If word of mouth, please specify:

Next steps: Please choose one of the options below*

Hanen More Than Words Program