Music Group March 30th – April 20th
Parent's First & Last Name
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Child's First & Last Name
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Child's Date of Birth
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Month
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Day
Year
Date
DDS Eligibility
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DDS
Autism Division
I have not applied for either
Applied waiting to hear back
I would like to attend
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10:00am - 10:45am (grades 6-8)
11:00am - 11:45am (grades 9-12)
Street Address
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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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Can this phone number receive text messages:
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Yes
No
I give Community Autism Resources, and their sponsors, 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
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
Are there any accommodations that you will need that we should be aware of (sensory, behavior, etc)?
Comments
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