Wings For Autism
Worcester Regional Airport: October 14, 2023
Primary Contact Registration
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
Transgender
Other
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to child/adult with disability
Parent
Sibling
Friend
Other
Back
Next
Registration
The maximum registration is 5 people including primary contact registration
How many children/adults WITH disabilities are your registering?
Please Select
0
1
2
3
4
Calculation - with disabilities
Child/Adult 1
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
Transgender
Other
Diagnosis of child/adult with disability
Autism
Asperger Syndrome
PDD-NOS
Other
T-shirt size of child/adult with disability
Please Select
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Child/Adult 2
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
Transgender
Other
Diagnosis of child/adult with disability
Autism
Asperger Syndrome
PDD-NOS
Other
T-shirt size of child/adult with disability
Please Select
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Child/Adult 3
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
Transgender
Other
Diagnosis of child/adult with disability
Autism
Asperger Syndrome
PDD-NOS
Other
T-shirt size of child/adult with disability
Please Select
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Child/Adult 4
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
Transgender
Other
Diagnosis of child/adult with disability
Autism
Asperger Syndrome
PDD-NOS
Other
T-shirt size of child/adult with disability
Please Select
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Back
Next
Registration (continued)
The maximum registration is 5 people including primary parent registration
How many children/adults WITHOUT disabilities are your registering?
Please Select
0
1
2
3
4
Calculation - without disabilities
Child/Adult 1
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
Transgender
Other
Relationship to child/adult with disability
Parent
Sibling
Friend
Other
Child/Adult 2
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
Transgender
Other
Relationship to child/adult with disability
Parent
Sibling
Friend
Other
Child/Adult 3
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
Transgender
Other
Relationship to child/adult with disability
Parent
Sibling
Friend
Other
Child/Adult 4
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
Transgender
Other
Relationship to child/adult with disability
Parent
Sibling
Friend
Other
Back
Next
Registration (continued)
The maximum registration is 5 people including primary contact registration
Calculation - additional attendees
Additional Attendee 1
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
Transgender
Other
Is address the same as your primary address?
Yes
No
Address (if different from primary address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to child/adult with disability
Parent
Sibling
Friend
Other
Additional Attendee 2
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Gender
Please Select
Male
Female
Non Binary
Transgender
Other
Is address the same as your primary address?
Yes
No
Address (if different from primary address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to child/adult with disability
Parent
Sibling
Friend
Other
Additional Attendee 3
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
Transgender
Other
Is address the same as your primary address?
Yes
No
Address (if different from primary address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to child/adult with disability
Parent
Sibling
Friend
Other
Please indicate your permission to publish photo\video\audio of all members of your party in connection with media/internet activities for Wings For Autism®
PERMISSION TO ALLOW PHOTO/VIDEO/AUDIO PUBLISHED
Yes
No
Calculation - total attendees
Error:
the maximum registration is 5 people, including primary parent registration.
Submit
Should be Empty: