Contact Form

Child's Full Name*

Birth Date *

Child's Gender

Male Female Unspecified

Is your child a Canadian Citizen?

Yes No

Parent/Guardian Full Name*

Email *

Phone Number

Area of Concern:

Speech and Language Behaviour Fine Motor Skills Large Motor Skills Other

If you selected "Other" to Area of Concern:

Diagnosis:

Suspected Confirmed

What is your child's suspected or confirmed diagnosis?

Has your child ever received ECS support service funding?

Yes No Unsure

If your child has accessed PUF before, where did they attend?

How did you hear about our independent kindergarten program?

Further details about your child

This page contains separate forms for the Kindergarten program and ECS Support, please scroll to your desired form.