Autism Programme Application Form

Please complete the form below to register your interest in our autism programme. Once we have a date confirmed for the next information day we will then send you an email to invite you to apply for a place to attend it. Spaces at these information days are limited and are allocated on a first come first served basis to those that meet the programme criteria.

Email address (required)

Your name (required)

Address (required)

Town/City (required)

Postcode (required)

As a small charity it is vital to us that we are able to keep you up to date on our work and activities by sending you occasional emails about our work, events, appeals and fundraising. Please tick to allow us to do this

Yes I am happy to receive this

Phone Number (required)

Is your child aged between three years old and eight years old? (required)

Yes

Child’s date of birth (required)

Child’s name (required)

Does your child have a confirmed diagnosis of autism

Yes

How would you describe your ethnicity? (optional - We are ask this question to collect data to ensure we are doing our best to help all communities in the UK)

Send