P2P Sign up
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1.
First & Last Name
(Required.)
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2.
Phone Number
(Required.)
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3.
Email address
(Required.)
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4.
Pronoun
(Required.)
She/Her
He/Him
They/Them
Other (please specify)
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5.
Address
(Required.)
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6.
Age
(Required.)
18-24
25-34
35-44
45-54
55-64
65+
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7.
Affiliation with the community
(Required.)
I am a parent of a child with a difference
I am a person living with a difference
8.
Please list your or your child's facial difference below.
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9.
Something that I am currently finding challenging is
(Required.)
Social events and/or interactions
Finding employment
Medical/Dental care
Overall stress
Self confidence and self worth
Substance use
Other (please specify)
10.
Do you identify as part of any of the following groups (check all that apply)
BIPOC (Black, Indigenous or Person of Colour)
LGBTQ2SIA+
Newcomer/Refugee
Disabled
Other (please specify)
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11.
Something I find joy in
(Required.)
Sports
Art based activities
Music (Making and or listening)
Mindfulness activities
Cooking/Baking
Being outdoors
Reading
Gaming
Other (please specify)
12.
Are there any accessibility needs that you would like AboutFace to know about to ensure proper support is provided (ie: Vision/Hearing challenges, Mental Health concerns) (This question is NOT mandatory)
13.
Is there anything else that you would like AboutFace to consider when matching you with a peer volunteer?
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14.
Emergency Contact Information (please provide name of contact, relationship to you, and phone number)
(Required.)
