Happy Halloween Party Registration
Brought to you by Happy Feat.
Participant Media & Liability Rights Release
Please download and sign the release waiver and bring it with you to the event. http://happyfeat.org/wp-content/uploads/2016/02/Happyfeat-Halloween-Release-Form.pdf
PARTICIPANT & PARENT INFORMATION
Name of Child *
Your answer
Child's Birthdate *
Your answer
Child's Age *
Your answer
Gender *
Parent/Caretaker Name(s) *
Your answer
Parent/Caretaker Phone *
Your answer
Email for Event Information *
Your answer
Care Provider Agency Information (if applicable)
Care Provider Agency
(If attending as a part of a group, please include agency or company name)
Your answer
Care Provider Agency Phone
Your answer
Agency Chaperone (if applicable)
(Note: Chaperone is not required to stay with guest(s) unless required by Care Provider Agency)
Your answer
Additional Notes or Concerns
Your answer
EMERGENCY CONTACT
Emergency Contact Name (and relationship) *
Your answer
Emergency Contact Cell Phone *
Your answer
MEDICAL INFORMATION
In case of an accident or other emergency.
Health Insurance Company Name *
Your answer
Health Insurance Group Name
Your answer
Health Insurance Policy #
Your answer
Allergies
Your answer
Additional Health Information/Activities to be Limited
Your answer
Sensory Issues/Concerns (strobe lights, camera flashes, loud noises, etc.)
Your answer
Wheelchair
Special Communication Needs
If yes, please explain
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms