RSVP

Parent/Registrant's name（家長姓名） *

First

Last

Name of child receiving RC services（子女姓名） *

First

Last

Email Address（電子郵件） *

Phone number (電話) * *

Home address 地址 (Address, City, Zip Code) (城市,郵政號碼) * *

Diagnosis of family member receiving RC services (有特殊需要家庭成員的診斷) *

Regional Center belong to (您的區域中心) *

Language spoken (語言 ） *

• English (英語)
• Cantonese (廣東話
• Mandarin (普通話）
• Other (其他)

RSVP Response

• Yes
• No

Will any additional guest(s) attend?

• Yes
• No

If so, please specify guest name(s) and relation(s).

Please let us know if you have any questions or comments.

Submit