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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 ECS Inquiry Form
Child's Full Name
Child's Date of Birth
Child's Gender
Male
Female
Unspecified
Is your child a Canadian Citizen?
Yes
No
Languages most frequently spoken at home:
Will your child require transportation?
Yes
No
Undecided
Home Address
Postal Code
Community Name
Phone Number
Email
Parent/Guardian Name
Area of Concern:
Speech Language Pathology
Occupational Therapy
Physiotherapy
Behavioural Strategy
Other
If you selected "Other" to Area of Concern:
Diagnosis:
Suspected
Confirmed
What is your child's suspected or confirmed diagnosis?
Has your child accessed PUF (Program Unit Funding) before?
Yes
No
Unsure
If your child has accessed PUF before, where did they attend?
Family Support for Children with Disabilities (FSCD) Application Status
Not yet applied
Applied - on waitlist
Active agreement with caseworker
Would you like to be connected with our In-Home Intake Coordinator to discuss FSCD programming options?
Yes, please share my contact information
No thank you
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
If "Other," please tell us how:
Subscribe me to the ECS e-newsletter for the latest updates and resources.
Yes!
No, thank you.
Please read and confirm to complete your form
Thank you for your interest in Pacekids ECS Programs. We are currently receiving a very high volume of inquiries. Our ECS Coordinators will respond as soon as possible. If this is urgent, please call 403-234-7876.
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