Virtual Program Registration

In the event that we would need to cancel a program, please list the best E-MAIL to contact. We may be unable to make phone calls due to last minute cancellations or large attendance number.

E-MAIL

Participant's Full Name

First NameLast Name

Phone Number of Individual Registering

Area CodePhone Number

E-mail

example@example.com

Name of Individual Registering for the Participant

First NameLast Name

SOAR Membership - please read- Forms also available to fill out online this year!

Family Programs

Please write names/birthday of each individual attending Mini but Mighty

Please list names attending 5/30 Sensory Friendly Safety Day- Registration required to receive Safety Resource Kit. 1 kit per Family

8/27-ANNUAL CORN ROAST- 5:30-8:00pm. Registration required. Capacity 200 people. Register by 8/20. See Flyer in August newsletter for details!

Rows	Number Attending (over 5 years old)	under 5 years FREE
$8/Person (Registration Required)

REQUIRED: Please add names of each person you are registering if attending ANNUAL CORN ROAST Event (list ages of those attending only 5 years old and under):

**if arriving as a group with group home / adult family home / or adult living facility- please list name of HOUSE or GROUP name also for check-in

Youth Programs

March Super Sunday-

March Super Sunday- Caregiver

Adult Programs

If attending SUNDAY FUNDAY event 7/5, please indicate which meal option you would like to have from the Good Company menu located towards the end of the newsletter.

Information REQUIRED if attending Dinner & a Movie. Dinner at EL AZTECA before movie. Please see insert in newsletter with menu options (make sure to put meat choice if it is an option). Please fill in all items.

Young Adult Programs- Open ONLY to participants ages 18-30.

If attending "Chili's & Soda Bar with Jackie" please indicate all of the following. The menu options can be found at the end of your Newsletter. Remember to bring your own money if ordering anything at Soda Bar

Please indicate which Board and Brush project choice you would like to make:

See flyer in newsletter for choices.

If you are a CAREGIVER than plans to attend an activity with your participant, please indicate which activities below:

If you are a caregiver attending SUNDAY FUNDAY 7/5, please indicate which Good Company meal option you would like to eat. See insert in newsletter for # options.

If you are a CAREGIVER attending "Dinner and a Movie" Note that you will choose your meal option now and pay at the event. Meal choices can be found at the end of the newsletter. Please fill out all areas below.

Please List name of Caregiver attending 7/22 SOARing Around The World event. Cost is $5 per caregiver. Please call to register if registering more than 1 caregiver.

Total Participant Program Fees

This Number will auto-fill from selections made above.

Please indicate how you will pay for your participant program fees:

Who is your third-party payer?

ie- IRIS, Lakeland, CLTS

Total Caregiver Fees

This Number will auto-fill from selections made above.

Please indicate how you will pay for your caregiver program fees:

Total Family Program Fees

This Number will auto-fill from selections made above

Please indicate how you will pay for your family program fees:

Total Amount Due (Participant, Family, & Caregiver Program Fees)

PAST REGISTRATION DATE: These activities may have spots available, but registration has closed. PLEASE CALL to inquire about attending these activities- (920) 731-9831 x 100

WAITLIST: THIS IS NOT A REGISTRATION TO THE EVENT! These activities have reached their max capacity. DO NOT pay and DO NOT come to the event unless we contact you about openings, but you will be added to the waitlist in case someone cancels:

Multiply by Zero - If/Then

Comments or Questions

Total Due by Card Now

USDPLEASE COMPLETE PAYMENT METHOD BELOW BEFORE HITTING 'SUBMIT'

Private Participant: Amount Due Now

Private Family:Amount Due Now

Private Caregiver: Amount Due Now

Private Participant+Caregiver+Family: Amount Due Now

Total Packers Participant Fees

We can't wait to see you! Please write name of each person attending the Holiday Party.

Information REQUIRED if attending 6/10 Brewers Tailgating & Game outing. *IMPORTANT- BREWERS STADIUM IS CASHLESS*

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Program Registration Form

Select all activities participant would like to sign up for.

Total Due by Card Now

Payment Methods