Sibshops Application

Tell Us About the Child You'd Like to Enroll
Child's Name*
First Middle Last
Birth Date*
Month
Day
Year
Age*
Gender*
- Male
- Female
School*
Grade*
Tell Us About You
Mother's Name
First Last
Father's Name
First Last
Home Address*
Street Address City State ZIP Code
Email*
Cell Phone*
Emergency Contact
Emergency (alternate) Contact Name*
First Last
Phone
Tell Us About The Brother or Sister with Special Needs
Name*
First Last
Birth Date*
Month
Day
Year
Age*
Gender*
- Male
- Female
School*
Grade*
Name or description of disability, diagnosis, or health concern
Related Services
What kind of related special education services (e.g., speech, occupational or physical therapy, counseling, chemotherapy, etc.) does this child receive? Include date of diagnosis and other important details.
Tell Us About Their Other Siblings
How many other siblings besides these two?
Name
First Last
Age
Gender
- Male
- Female
Name
First Last
Age
Gender
- Male
- Female
Name
First Last
Age
Gender
- Male
- Female
Name
First Last
Age
Gender
- Male
- Female
Name
First Last
Age
Gender
- Male
- Female
Tell Us Additional Information
What do you hope your child will gain from our Sibshop*? Are there any particular topics you would like addressed?
Does your enrolled child have any special needs, food allergies, or other health restrictions of their own that we should know about?
Please provide any other information that you feel would make Sibshops a more enjoyable and educational experience for your child.
Would you like your name placed on a list to be distributed to siblings and their families?
- Yes
- No
Would you like your phone number included?
- Yes
- No
Comments
Authorization (form cannot be submitted without this)*
I hereby give my child permission to participate in Sibshops. I also agree to hold Project Joy and Hope harmless for any and all liability incurred as a result of my child’s participation. Further, I grant full permission to use any photographs, videotapes, recordings or any other record of this program for the purpose of education and promotion of Sibshops.
- Yes
Signature*
Please sign with your mouse or finger.
Date*
MM slash DD slash YYYY
Our staff will call you upon receipt of this completed form to go over final details, answer any additional questions you may have, and provide directions to the Sibshop.

Sibshop Dates: Second Saturdays monthly beginning Saturday, September 10th, 2022

Summer Camp Dates: June 21, 22, and 23, 2022 (free) for all students with excellent attendance.
For information or to register by phone call 713-944-6569

*Sibshop and Sibshops are service marks and trademarks owned by Donald J. Meyer on behalf of the Sibling Support Project.

Sibshops Workshops for Siblings of Children with Special Needs, Revised Edition, by Don Meyer and Patricia Vadasy. Copyright©2008. Paul H. Brookes Publishing Co. All rights reserved.