Introduction to Autism in Early Childhood EducationOne workshop open to all, centre visits and final workshop for up to 20 centresRegistration Form

Autism New Zealand is delighted to present this Intro to Autism programme thanks to Ministry of Education Hawkes Bay, Strengthening Early Learning Opportunities (SELO) funding.Please see the reverse side for more information.

Programme Details: Intro to Autism, May – June 2017

Personal Details *indicates a required field

First Name*       Surname*      

School Name*      

School’s Service ID*       Contact Number(including area code)      

School’s Full Address (including postcode)*      

Position in School*      

Personal Email Address      

School’s Email Address*      

Ethnicity       Gender      

We have a child/children with additional needs (diagnosis not required) and would like a centre visitHow did you hear about this programme?AutismNZ Staff Website Facebook School MoE

Other (please specify)      

Autism New Zealand Membership (automatic)By signing up to this programme you agree for you and your school to be added to the Autism New Zealand Membership.Tick here to receive email updates and further information from Autism New ZealandOther Ways to Help Please indicate if you’d like us to contact you about the following

Information about volunteering Information on making a regular donation Information on making a bequest

Donating Please indicate if you’d like to make a donation

1Autism New Zealand Introduction to Autism in Early Childhood Education: Last Updated 7/05/2023Author: Morgan Ryan, Education Coordinator R:\Education\Registration Form Master Copies

Introduction to Autism in Early Childhood EducationOne workshop open to all, centre visits and final workshop for up to 20 centresRegistration FormI would like to make a $      donation to Autism New Zealand Cheque Please make cheques payable to ‘Autism New Zealand’

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Card Number      Name on Card      Expiry       CCV Number      

Direct Banking

Amount Paid $      Date Paid      Account details: Autism New Zealand, 03 0866 0356307 01Direct banking reference: W2P, Area of Programme, Participant Name

Invoice

Please provide details of who to send the invoice to (i.e. accounts):Name      Physical Address      Email Address      

Important InformationRegistration: Completed forms must be sent to Autism New Zealand prior to the programme. The initial workshop is open to all participants (family/whanau or professional). Centre visits are only available for the first 20 centres with a child with autism. Each centre may send 2 – 3 participants (family/whanau or staff) to the initial workshop. If only one person from your centre may attend this will be accepted but is not recommended. Acceptance is on a first come-first served basis.

Dates and Times:Initial Workshop (open to all), 26 May, 9:30am – 3:30pmCentre Visit, either 7 or 8 June, times to be arranged with your Educator. A workshop participant and the child with autism must be present for your centre visit.Final Workshop, 14 June, 2pm – 4pm

Confirmation: Participants will receive an email response acknowledging the receipt of their form at the time it is read. Forms not sent through email may not receive an acknowledgement. All participants will receive a confirmation/reminder email around two weeks prior to the programme starting. If no email address is provided we cannot confirm you will receive a reminder.Autism New Zealand reserves the right to change, postpone, or cancel our education programmes at our discretion. Registered participants will be notified by email as soon as possible.Maximum participants (can be changed at Autism New Zealand’s discretion): Up to 20 centres for visits and 50 people for the workshops.Minimum participants (programme subject to postponement or cancellation if not reached): 10 centres for visits and 15 people for the workshops.

When completed, please return with payment to Autism New Zealand, National Office

Email: training@autismnz.org.nz (preferred)Postal: PO Box 33481, Petone, Lower Hutt 5046 Fax: 04 803 3502, Ph: 04 803 3501Website: http://www.autismnz.org.nz Please check the website for contact details of your local Autism New Zealand Branch

2Autism New Zealand Introduction to Autism in Early Childhood Education: Last Updated 7/05/2023Author: Morgan Ryan, Education Coordinator R:\Education\Registration Form Master Copies