The Shoals Center Application/Registration Form
If you have previously completed this form and have no changes in information, you will not be required to answer every question. Thank you for supporting The Shoals Center!
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Email *
Participant's name *
Participant's gender/pronouns
Participant's current age
Participant's date of birth
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Does participant toilet independently? (Recognizes need to eliminate and can manage clothing without assistance?)
Does participant have any known allergies? If so, what are they? *
Please list any sensitivities here.
What is participant's history with school/group involvement?
Do you anticipate any difficult drop-offs? If so, would you like to schedule a phone chat to discuss strategy?
For what program are you applying/registering? *
Please specify any dates in the next section.
Required
Please specify dates and times (if applicable.)
Would you be comfortable with your child traveling on field trips via the city bus system? *
May the participant consume foods not listed in allergies and sensitivies provided by The Shoals Center or other families? (Foods containing artificial colors, flavors, and preservatives will never be served.) *
Do you consent to the participant's photos being used for promotional purposes, without the use of name? *
Would you (or a representative) be interested, willing, and available to contribute time to the program in any of the following ways?
If you are willing to contribute time, please describe what you could offer.
How did you find out about The Shoals Center?
Please share a few thoughts about why you think The Shoals Center would be a good fit for your family.
What concerns might you have about participation at The Shoals Center?
Caregiver's name *
Email *
Address
Phone *
Second contact person and phone number
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