Voice/Text:
604-684-1860
To apply for a buddy, please fill in the blanks.
All fields with asterik character (*) cannnot be left blank.
Name of parent(s)*:
Name of child*:
Age of child*:
Attends school at*:
Grade*:
Please select
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Your home address*:
Phone number:
E-mail address*:
Your child is...*
[check all that apply]
Deaf
Hard of Hearing
Hearing Child of Deaf Parents
Cochlear Implant
First language in the home*:
My child's preferred communication mode is*:
Please select
ASL
Signed English
Spoken English
Signs and Spoken English
Other...
Other:
My child has the following additional special needs:
He/she has the following allergies?
Are you near public transit*?
Yes
No
Would your child prefer*:
Please select
Male Buddy
Female Buddy
Doesn't matter
What kinds of things does your child like to do?
(Ie: cooking, art, sports, games, etc)
