Spotlight Series Registration
Event Date: Thursday, March 14th, 2019

Doors will open at 5:45 p.m.

Check In Time: 5:45 p.m., with presentation beginning promptly at 6:00pm

Event Location: Verne Cox Multipurpose Recreation Center

Event Address: 5200 Burke Rd. Pasadena. TX 77504

Contact us: 281.487.1755 or

Spotlight Series Presents: Kim Hegwood from Hegwood Law Group: Life After 18
Presentation Attendee Information:
First & Last Name *
Your answer
Email *
Your answer
Phone *
Your answer
How do you prefer to be reminded? *
During the presentation, the VCMRC will have staff available for Supervised Open Gym, offered to participants that require 1:1 assistance and to those that cannot be left home alone. The gym and staff will be available from 6:00pm until the conclusion of the presentation. Supervised Open Gym will be available for those ages 3+.
Will your Participant(s) need Supervised Open Gym during the presentation? *
If yes, please answer the following questions, for EACH Participant you are registering.
Participants' First & Last Name(s)
Your answer
Has your Participant attended the VCMRC within the last year?
Participants' Age(s)
Your answer
Participant's Disability(ies)
Your answer
Levels of Assistance
1 - Independent - Participant is able to follow 3-4 step instructions independently.
2 - Minimal Assist - Participant is able to complete 75% of the task, with cues.
3 - Moderate Assist - Participant is able to complete 50% of the task, with cues.
4 - Maximum Assist - Participant is able to complete 25% of the task, with cues.
5 - Total Assist - Participant requires 100% assistant to complete the task.
Level of Assistance needed for Participant(s) with disabilities. Type in level from above and elaborate if needed.
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service