FOCUS Support and Share Group's Children's Directory is designed to connect families with other families of similar needs.
This information will remain confidential if you choose not to share the data but will be used by FOCUS organization to better serve you.
If you select yes to share this information with other parents your information will remain confidential amongst the support group.
Your information will not be placed on the website at any time.
You may request a parent match by emailing privately to:
Candice Lange candice@sophtware.com
Or by contacting FOCUS at (770) 234-9111
Please copy the form to your email and send it directly to me at Candice@sophtware.com for your confidentiality.
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Directory Form
Focus Member? Yes/No
Parent 1:
Name:
Full Address:
Home Phone:
Work Phone:
Email:
Best way to contact and time:
Able to access child information: Yes / No
Permission to Share Data? Yes or No
Parent 2:
Name:
Full Address:
Home Phone:
Work Phone:
Email:
Best way to contact and time:
Able to access child information: Yes / No
Permission to Share Data? Yes or No
Information for each of your children:
Child 1:
Birth
School
Grade
Class
Diagnosis
Permission to Share Data? Yes or No
Child 2:
Birth
School
Grade
Class
Diagnosis
Permission to Share Data? Yes or No
Child 3:
Birth
School
Grade
Class
Diagnosis
Permission to Share Data? Yes or No
Child 4:
Birth
School
Grade
Class
Diagnosis
Permission to Share Data? Yes or No