Wufoo

Family Resource Day Registration

In order for us to properly plan for the day's needs, please complete this form. Pre-registration is required if you need childcare.

First Name

Tip: If you need to register more than one person, please fill the form out twice.
Last Name

Tip: If you need to register more than one person, please fill the form out twice.
Address
City
State
Zip
Telephone
Email
Childcare
Do you require childcare? Yes No
If you need childcare, please provide names, ages and hours during which childcare is needed.
Child(ren)'s Name(s) and Age(s)
Hours when childcare is needed
For planning purposes, please indicate below which workshop(s) you are considering: Workshop #1 - Ages 18 Months to 3 Years: From Early Intervention to Pre-School Workshop #2 - Ages 5-15: Yearly Transitions Workshop #3 - Ages 15-21: Teens and Young Adults Workshop #4 - Transitions to Middle Age and Beyond Workshop #5 - Self-Advocacy and Planning for the Future Keynote Panel - Legislation and Community Life - Where Are We Going?
Anything else you would like us to know?
Other information
Thank you!

When you click the button below, your registration request is sent to:
Regina Moore
rmoore@westchesterarc.org
(914) 949-9300 x3117
Do Not Fill This Out