Learning Disabilities Association South Vancouver Island LDA Child and Youth Registration - Learning Disabilities Association South Vancouver Island

Which session(s) are you registering for? *

Child/Youth Name *

Date of birth (DDMMYYYY) *

Email Address *

Home Address *

City *

Province *

Postal Code *

Parent's Name *

Parent's Daytime Phone *

Has the applicant been assessed or diagnosed with any of the following? *

If you selected "Other" for the above question, please specify what the applicant has been assessed/diagnosed with

Does your child struggle in school? *

Do you have any concern about your child's learning or behavior development? *

If so, please describe your concerns

If available, do you require financial assistance? *

Would you prefer in-person or virtual (if available) *