Caregiver Mediated Program - Registration Form

Have a diagnosis of Autism Spectrum Disorder, and not yet registered with the Ontario Autism Program?Contact Access OAP at 1-833-425-2445 or visit
Require technical support or having trouble registering?Contact Child & Community Resources at 1-877-996-1599

General Information

Child Name(Required)
MM slash DD slash YYYY
Primary Contact Name(Required)


Accepted file types: jpg, png, pdf, Max. file size: 512 MB.
Select your service area:(Required)

If in-person services are not available in your service area, would you consider receiving services virtually?(Required)
Please select your preferred program:(Required)