Step Up Squad Interest Form

Step Up Squad Interest Form

Please fill out the following information to ensure we provide appropriate activities for all children involved with Step Up Squad.
Full Name of PARENT

First NameLast Name
Full Name of CHILD

First NameLast Name
Child's D.O.B.

Current AgeBirthday DD/MM/YYYY
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Reasons for your CHILD Joining: **Please be specific.** Write down if you are joining because your child has a limb-difference, limb loss, or dwarfism. Include their age and level of mobility. Add any additional notes about their unique condition that will help us better prepare!
Are you an ADULT with Dwarfism, Limb Loss, Amputation, or a Limb Difference that wants to help mentor, coach, or volunteer? All Adults will require a Background Check (paid for by Step Up Squad). Please list your name, age, condition, and goals and we will follow-up prior to camp. If not, please write N/A in this section.