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Autism Registry Registration Form

Address
Valid format: (506) 555-1234
Valid format: (506) 555-1234
Valid format: dd/mm/yyyy

Emergency Contact Information

Primary Contact Information
Primary contact address if different from above
Secondary Contact Information
Secondary contact address if different from above

Answer any or all of the Following Questions

One file only.
22 MB limit.
Allowed types: doc, docx, pdf, jpg, jpeg, png.
Height
feet
inches
(in pounds)
Does your loved-one use any of the following
If yes, please select all that apply
If yes, please select any causes that apply
Your personal data will be used for the sole purpose of the autism registry and will not be shared. All of your data will be kept secure. If you have any other questions or concerns about this statement you may contact the Saint John Police Force.