Kickball (July 22nd)
*Important please read before filling out the form.
1. Do not fill out this form until you are definitely attending the event.
If you have any questions please call Ross at 908-616-5091 or send an email to
Full name of the event attendee:
Cell phone number of the event attendee:
Gender of the event attendee:
Does not wish to respond
Age of the event attendee:
Will this be the first Disability Allies event the attendee has attended?
Which of the following describes how the attendee will participate?
(Mentees are individuals who attend the event to meet and build relationships with others for support and guidance. Mentors are those who attend events to provide guidance to mentees. We recommend that individuals who would like to be mentors are confident in their interpersonal skills and ability to encourage mentee engagement.)
Please enter the contact person's name
(If another individual needs to be given event information on behalf of the event attendee, enter that person's name. If the contact person is the attendee named above, please enter that name again)
Cell phone number of the contact person
(If another individual needs to be given event information on behalf of the event attendee, enter that person's name. If the contact person is the attendee named above, please enter that phone number again)
Please enter the contact person's email address
(If the contact person's email is the same as the email address listed above, please enter that email again)
How did you hear about this event?
(Please select all that apply)
Friends or family
Disability Allies Website
as a member of Disability Allies staff
Would you like notifications of future events to be sent to the contact person’s email address above?
How confortable is the attendee with their social skills
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