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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 Bay of Plenty, Strengthening Early Learning Opportunities (SELO) funding.Please see the reverse side for more information.
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 visit
Programme DetailsDate & Location of Intro to Autism Programme (click for drop down menu) Select
How 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
1Autism New Zealand Introduction to Autism in Early Childhood Education: Last Updated 9/05/2023Author: 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 FormDonating Please indicate if you’d like to make a donation I 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 (more participants may be sent if space permits). 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 (please note that these may be changed, any changes will be communicated via email):
Taupo/Turangi
Initial Workshop (open to all), 8 August, 9:30am – 3:30pmCentre Visit, either 22 or 23 August, times to be arranged with your Educator. A workshop participant and the child with additional needs must be present for your centre visit.Final Workshop, 29 August, 12:30 – 2:30pm.
Rotorua
Initial Workshop (open to all), 10 November, 9:30am – 3:30pmCentre Visit, either 30 November or 1 December, times to be arranged with your Educator. A workshop participant and the child with additional needs must be present for your centre visit.Final Workshop, 7 December, 12:30 – 2:30pm.
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 who provide an email address 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: [email protected] (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 9/05/2023Author: Morgan Ryan, Education Coordinator R:\Education\Registration Form Master Copies