Halloween Family Registration

1

Parent/Guardian Full Name* This field is required.

First Name

Last Name

2

Email Address* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

City You Live In

5

How many children attending* This field is required.

6

Are you currently an E-Community Outreach Services member?* This field is required.

Yes

No

Not sure

7

If you are not currently a member, would you like information about becoming an ECOS member?

Yes

No

I am already a member

9

Does anyone in your household have a food allergy or other accommodation we should be aware of?

No

Yes — Please explain: __________

10

Would you like to receive information about upcoming ECOS family events, programs, resources, and giveaways?

Yes

No

11

Please confirm the following:

I understand that completing this form registers my household for the event.

I understand that children must be accompanied by a parent or responsible adult.

I understand that registration does not guarantee specific giveaway items.

I understand that photos and videos may be taken during the community event.

12

Electronic Signature* This field is required.

13

Date* This field is required.

Date