TLC Adventures Registration Form
Please complete this registration form if you are interested in learning more about classes that are being offered!  We will use this registration form to identify interests in activities, form potential groups, schedule outings, etc.

Someone will contact you regarding levels of experience, group size preference and your availability.
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Email *
Name of person completing the form *
Phone number (cell phone preferred) *
Name of Individual participating in classes *
Date of Birth *
MM
/
DD
/
YYYY
Town of residence
Activities
Interested
Kids on the Trail
Kayaking Adventures
Trail Walkers
Collaborative/Cooperative
Team/Social Activities
Winter Activities
Level of supervision necessary
Any accommodations needed?
Self Direction program, Fiscal Intermediary (FI)?
Self Direction program, self pay or  we invoice the FI?
Clear selection
Self Direction program,  FI Coordinator?
Self Direction program, Broker?
Self Direction program, Care Manager?
Will individual come with a support staff?
Clear selection
Please list any individuals (service providers, etc) that you authorize me to have permission to speak with as it relates to providing you this service.
What other activities would you be interested in participating in if we offered?
Submit
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