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Putting For Pace
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About Us
Our Work
Blog
Media & Publications
Testimonials
Our Future
Our Leadership
Programs
Preschool + Kindergarten (PUF)
In-Home / In-Community (FSCD)
Private Assessment and Therapy
Get Involved
Be a Champion for Children
Events
Keeping Pace
Putting For Pace
Race for Pace
Other Ways to Give
Careers
Donate
Contact Us
Pacekids Programs Community and In-Home Inquiry Form
Child's Full Name
Child's Date of Birth
Child's School Name
Child's School Hours
Parent/Guardian Name
Email
Phone
Address (Including city to confirm programming availability)
Timeslot(s) you and your child are available for programming (Pacekids offers programming Monday - Friday. For scheduling purposes, families must be available for programming 3- 4 days a week at the same time each day)
10:00am -12:00pm
1:00pm -3:00pm
4:00pm -6:00pm
Do you have an active FSCD agreement and caseworker
Yes
No
I have applied and am waiting to hear back from FSCD
How did you hear about Pacekids?
Pediatrician
Therapy Provider (SLP, Psychologist, OT, PT, etc.)
FSCD Coordinator/Caseworker
AHS Community Education Services
Google/Online Search
Social Media (Facebook, Instagram, LinkedIn, YouTube)
Website/Blog
Open House Event
Information Session/Community Presentation (Library, Community Association, etc.)
Community Program (Autism Network, CUPS, Centre for Newcomers, etc.)
Friend/Family Referral
Pacekids Staff Member
Mail/Flyer
Calgary's Child Magazine
Daycare/Dayhome Provider
Other
Please read and confirm to complete your form
Thank you for your interest in Pacekids CIH Programs. Our CIH Coordinators will respond as soon as possible. If this is urgent, please call 403-234-7876.
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