DASH ONLINE REGISTRATION
This form is for every DASH experience. Sign up so that we have a head count for the event. On your first day we will go over our photo release form, diabetes management information, drop off and pick up instructions and vital contact information.
Which event are you signing up for and for which dates?
What are your first & last names and what is your preferred name if different ?
What is your age?
How did you hear about DASH?
What's your phone number and or email ?
How would you rate your income status?
Medium Low Income
Medium High Income
Do you receive state sponsored school lunch or breakfast?
How many times a week do you play, exercise or go outside for fun?
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