Sibshops Registration | Easterseals Northeast Indiana

Child's School(Required)

Child's Grade(Required)

Child's Gender(Required)

Child's Age(Required)

Your Home Address

Your City

Your State

Your Zip Code(Required)

Your Country

Your Phone

Your Secondary Phone

Email(Required)

Name of Sibling With Special Needs(Required)

Sibling's Gender(Required)

Sibling's Age(Required)

Sibling's School(Required)

Please provide the name and/or description of your child's disability or health concern.

How do you hope your child will benefit from our Sibshops?

Does your enrolled child have any special needs, food allergies or other health restriction of their own that we should know about?

Is there any other information we should know that would make Sibshops a more enjoyable and educational experience for your child?