Contact information

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Address

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Apartment, suite, etc. (optional)
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Additional details

Participant's Name ?

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Participant's Age?

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Participant's T-Shirt Size?

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Does the participant have any accessibility accommodations? (i.e. Wheelchair, etc.)

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Is the participant verbal or non-verbal? Do they prefer to communicate in a certain way?

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Please confirm that you understand a parent/guardian or therapist must be in attendance with their teen at all outings. For in-house events, attendance is at your discretion.

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Will the participant be comfortable attending both in-house events at The Eliza Hope Foundation as well as field trip outings?

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Does the participant have any allergies that we should be aware of?

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Please feel free to detail anything else that would be helpful to know about the participant:

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Registration fee

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Apartment, suite, etc. (optional)
City

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ZIP code

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