Friday Night Fun
Monthly Meetings (Dates to be determined)
First & Last Name
*
Date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
*
.
Please include your mailing address so that we can mail any components necessary for the game (for example, Bingo cards)
Street
*
Town/City
*
State
*
Zip Code
*
Email (confirmations will be sent to this address)
*
Telephone Number
*
I understand that this event will be held once a month and the dates will be emailed out quarterly.
*
Yes
DDS Eligibility
*
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:
*
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:
*
Yes
Comments
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