PALS Interest Form

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PALS Interest Form

Thank you for your interest in PALS (Providing Autism Life Support)! We are a support group for autism moms in Sangamon County, IL.

Please complete the following form to indicate your preferences and needs. By completing this form, you will be added to the PALS email distribution list and will be contacted with PALS news and meeting notifications.

First and Last Name *

Email *

What role do you fill? *

mother

father

sibling

caregiver

Ages of children diagnosed with autism *

Tell us about your child(ren) with autism!

What topics are you hoping to cover at PALS? *

Would you require onsite childcare to attend support group meetings?

Yes

Clear selection

If you answered "yes" above, does your child require special supports?

What city do you live in?

Which PALS Group are you most likely to attend meetings for?

Chatham

Jacksonville

Clear selection

How did you hear about PALS? *

Submit

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