Complete The Puzzle's Cooking Creations Registration Form

Participant's Name*

First NameLast Name

Participant's Age*

Participant's Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent's Name*

First NameLast Name

Parent's Email Address*

example@example.com

Parent's Telephone Number*

Please enter a valid phone number.

Does the Participant have ASD (Autism Spectrum Disorder)?*

YesNo

Does the Participant have an Intellectual Disability?*

YesNo

Other Diagnoses?

Is the Participant verbal or nonverbal?*

If you selected "Other" please explain?

Can Participant follow 1 step directions?*

YesNoSomewhat

Does the participant have any food allergies?*

Will the Participant feel comfortable wearing an apron?*

YesNo

Are there any sensory concerns or accommodations that they would need?*

Any behavioral concerns we should be aware of?*

If you checked "Other" above, please explain?

Has Participant cooked before?*

YesNoYes, with parent

Photo Release Form - I hereby grant permission to Complete The Puzzle to use photographs and/or video of the participant and their parent participating in the cooking class, i.e. in publications, news releases, online, and in other communications related to the mission of Complete The Puzzle.*

YesNo

LIABILITY WAIVER: By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending this one day program, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the program may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Complete The Puzzle, the volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the event (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Complete The Puzzle, its volunteers, agents, and representatives, of and from the claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of Complete The Puzzle, the volunteers, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any of our programs.

Signature*

Complete The Puzzle's Cooking Creations Registration Form

PAYMENTS