Patient Education Evening Registration Form Your Child’s Name(Required) First Last Parent/Guardian(s) name(s):(Required) Email(Required) Enter Email Confirm Email Phone(Required)City of Residence(Required)Note: Parent education evenings currently only available at the Guelph VUE Clinic location Age of Child(Required) Grade(Required) Formal IEP (individualized educational plan) in place?(Required)YesNoPlease Indicate Type(Required)AccommodatedModifiedMain area(s) of concern(Required)(example: reading difficulty, frustration with reading, spelling issues etc.)Tell us about your child’s current struggles and how it is affecting them and also the family as a whole(Required)Limited Space Notice(Required) By checking this box, I / we understand that parent education evenings are limited in space and we will be notified of date options via email. Dates of Upcoming Events - Please Select Your Preference(Required)The presentation is expected to be 60 minutes with 30 minutes for questions.Thursday May 25th at 7:30pm - 9:00pmThursday June 22nd at 7:30pm - 9:00pmParent/Guardian(s) Only Notice(Required) By checking this box, I / we understand that this evening is for parent / guardian (s) only: Information Release(Required) By checking this box, I / we consent to communicate this information directly to Dr. Quaid Are you interested in a complimentary copy of Dr. Quaid’s book on Vision & Learning at the parent education event attended (limit of one per family)?(Required) I / we would like a copy Not interested.