Love for Littles - Project Intake Form

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Love for Littles - Project Intake Form

The Love for Littles project was initiated to provide families who have children with newly diagnosed disabilities a source of comfort, empathy and encouragement - in the form of a beautiful wellness package!

Each Love for Littles package contains meaningful items, packaged with love, which will:

celebrate that every child matters and every family's story is unique and deserves to be honoured
connect families to key resources, community, and the potential to build peer/natural supports
reduce feelings of isolation and encourage parents to reach out to others
affirm the right of every child and family to belong, to be valued, and to contribute

First and Last Name(s) of Parents *

E-mail: *

Phone Number(s): *

Street Address: *

City: *

Postal Code: *

First and Last Name of Child with New Diagnosis: *

Age of Child with New Diagnosis: *

Child's Date of Birth: *

YYYY

Child's Diagnosis: *

Name(s) of Other Siblings: *

Age(s) of Other Siblings: *

How did you hear about Love for Littles? *

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