The League Registration Form
Email address *
Participant's Name *
Your answer
Participant's Age *
Your answer
Address, City, and State *
Your answer
Participant's Phone Number *
Your answer
Parent/Guardian *
Your answer
Parent/Guardian Address (if different from participant's)
Your answer
Parent/Guardian's Phone Number *
Your answer
I give permission for my participant to participate in The League. I understand this is a social opportunity and not therapy. I also understand that facilitators will supervise this activity and I will pick up the participant at the end of this activity. Due care and diligence will be exercised at these events. I do not hold Red River Asperger-Autism Network, its staff or volunteers, or Moorhead Area Public Schools liable for any accidents or injuries during this event. This permission is valid until such time as the activity is no longer offered. I signify my agreement with these statements by writing my name and today's date in the text box below. *
Your answer
Are we able to use photos of the participant in our informational materials? *
Participant's Nickname
Your answer
Some things I'd like you to know about him/her
Your answer
His/her special interests (e.g. sports, art, games, movies, characters, etc.)
Your answer
Triggers for him/her
Your answer
Things that will soothe him/her
Your answer
What else would you like us to know to help make this a valuable experience?
Your answer
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