Derby Dreams & Cowboy Scenes

1

Which best describes you?* This field is required.

I am an individual with a disability registering myself

I am completing this form on behalf of someone with a disability

2

Participant Name* This field is required.

3

Which session will you attend?* This field is required.(Both sessions are currently available. Each session is limited to 20 craft participants and will be filled on a first-come basis.)

11 AM

1 PM

4

Plans change—we understand! If you’re unable to attend, please let us know so we can share your spot with another family.

You can email the SNC at hello@sncwv.org or call Hammer & Stain at 304-223-3600!

5

How many individuals will be participating in the craft activity?* This field is required.(Please note: Each session is limited to 20 craft participants. Caregivers are welcome to attend and assist but do not need to be included in this number.)

6

Is there anything you'd like us to know to better support the participant?(Optional)

7

Contact Information* This field is required.

Please enter the caregiver's name

Please enter your email

Please enter your phone

8

Confirmation* This field is required.

I understand this event is designed for individuals with special needs and that supplies are limited.