• Sibshops Registration Form

  • Please complete the form below to register for Little Sibsm SibKids or SibTeens. Fields marked marked with * are mandatory. For more information on the Sibshops programs, please call Rocchina Van Leeuwen, Social Worker and Clinical Practice Lead, at 905-855-2690, ext. 2346

    • Program Selection and Information 
    • Please select the Sibshops program you are registering for*
    • Participant/Sibling Information 
    • Date of Birth*
       - -
      2 digit day, 2 digit month, 4 digit year
    • Does this participant/sibling receive any support services (e.g., counselling, speech therapy, special education?)*
    • Parent/Caregiver Information 
    • Format: (000)000-0000.

    • Child Information 
    • Date of Birth*
       - -
      2 digit day, 2 digit month, 4 digit year
    • Additional Information 
    • Is the participant/sibling aware of the diagnosis?*
    • Additional Siblings (if applicable)
    • Do you have any concerns about enrolling the participant/sibling into the Sibshops program?*
    • Do you have any particular topics you would like addressed during Sibshops?*
    • Does the participant/sibling have any allergies or medical needs?*
    • Is there any other information about the participant/sibling that is important for us to know?*
    • Consent 

    • This form is being submitted with the knowledge and consent of name parents/legal guardians. ErinoakKids will always treat your personal details with the utmost care and will not share or sell your personal information. You may unsubscribe from receiving communications from ErinoakKids at any time. We are committed to keeping your information safe and confidential. We follow the rules set out in law about collecting, using and disclosing your personal information. For more information, please review our privacy policies publicly posted at erinoakkids.ca/privacy

    • Consent Received

    • Consent must be received to submit this form

    • Submission Date
       - -
      4 digit year, 2 digit month, 2 digit day
  • Should be Empty: