Signup for a Family Account

Code/Password
The automatic approval code can be obtained from Handicare in person. You can submit this form without the code and we will try to review and approve your account within two business days.

Father's Information Check here if the father will not have an account. Name First MI Last E-mail Address Your e-mail address is used as your login id. (Please see the staff at Handicare if you do not have an e-mail address.) Password Your password must be at least 5 characters. Password Confirmation Please enter your password a second time to confirm it. Question This question is used in case you lose your password. What's your mother's maiden name? What's your favorite pet's name? What's your home town? Answer This is the answer to the above question. Birthday Your birthday is also used in case you lose your password. Can we e-mail you with announcements? Occassionally, we use e-mail to send out announcements. We will NOT use e-mail for emergency purposes. Yes No

Mother's Information Check here if the mother will not have an account. Name First MI Last E-mail Address Your e-mail address is used as your login id. (Please see the staff at Handicare if you do not have an e-mail address.) Password Your password must be at least 5 characters. Password Confirmation Please enter your password a second time to confirm it. Question This question is used in case you lose your password. What's your mother's maiden name? What's your favorite pet's name? What's your home town? Answer This is the answer to the above question. Birthday Your birthday is also used in case you lose your password. Can we e-mail you with announcements? Occassionally, we use e-mail to send out announcements. We will NOT use e-mail for emergency purposes. Yes No

Children

Child 1

First	MI	Last

Birthday
If this child attends Handicare, then their birthday will be recognized in the Handicare family.

Attends Handicare
Does this child currently attend Handicare?
Yes No

Child 2

First	MI	Last

Birthday
If this child attends Handicare, then their birthday will be recognized in the Handicare family.

Attends Handicare
Does this child currently attend Handicare?
Yes No

Child 3

First	MI	Last

Birthday
If this child attends Handicare, then their birthday will be recognized in the Handicare family.

Attends Handicare
Does this child currently attend Handicare?
Yes No

Child 4

First	MI	Last

Birthday
If this child attends Handicare, then their birthday will be recognized in the Handicare family.

Attends Handicare
Does this child currently attend Handicare?
Yes No