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ReFresh ReStart with QuickStart Application Form

Please fill out the following form in full.

Parent Information











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Medical Information

Proof of diagnosis?





 

Childcare Funding Information

Will childcare funding be needed?





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Please Note:

If sending your proof of diagnosis by mail, please e-mail info@quickstartautism.ca for our mailing address.

A valid credit card is required to confirm your reservation and when you check-in.  However, the hotel stay is complimentary.

This year parents will be selected through a lottery draw.

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