Registration

Registration

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Event:

Start Date/Time:

End Date/Time:

Fee per Family:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info (Not Contact #1 or #2)*

Add New Student #1:

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	Student's First Name: *	Last Name: *
	Birth Date: *	(format=mm/dd/yyyy)
	Grade Level:*
	Disabilities (Leave blank if NONE):
	Allergies (Leave blank if NONE):

Questions/Options:


Athlete Full Name:*
Athlete's Preferred Name:
Athlete's Date of Birth*
Parent/Guardian Names:*
Best Phone Number/email*
Emergency Contact Information *
Are there any physical limitations, mobility concerns, or restrictions?
Does your athlete us any adaptive equipment?
Does your athlete have any sensory sensitivities? (noise, lights, touch, etc.)
Are there any triggers that may cause frustration, anxiety, or overstimulation?
What helps your athlete calm down or refocus if overwhelmed?
Does your athletes require medication during practice or events?
What is the best way to communicate with your athlete?
Are there phrases, cues, or coaching techniques that work especially well?
Has your athlete participated in cheer, dance, gymnastics, or sports before?
Does your athlete have experience in performing in front of crowds?
Will your athlete require a parent, aide, or buddy present?
Does your athlete receive support services at school or elsewhere?

Additional Information:

Other Questions/Comments: