Friday Night Fun
Nov 19, 2021
First & Last Name
*
Date of birth/Age
*
.
DDS Eligibility
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DDS
Autism Division
I give Community Autism Resources permission to have myself, my family members, or any person(s) that I have registered for this Event to be photographed/ videotaped for educational/publicity purposes only:
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Yes
No
I understand that participation in this event is at our own risk and will not hold Community Autism Resources liable for personal injury or loss/damage of personal property:
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Yes
Town/City
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State
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Zip Code
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Email (confirmations will be sent to this address)
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Telephone Number
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I hereby agree to notify CAR if I am unable to attend this event (either via email or phone listed on confirmation). Notification should be received prior to the event or up to 24 hours after the event whenever possible. If such notification is not received by CAR, I understand that I will be unable to attend CAR events for 6 months from the date of this event.
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Yes
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