Guest Registration - Registration System

1. About the Guest

Legal First Name *

Last Name *

Preferred First Name (if different from Legal First Name)

Date of Birth * (Must be 14+ years old by date of event)

Gender * Male Female

2. Address and Contact

Address *

City *

State *

ZIP Code *

Email Address *

Phone Number *

3. Caregiver and Emergency Contacts

Caregiver Contact Name During the Event *

Caregiver Contact Phone *

Emergency Contact Name *

Emergency Contact Phone *

4. Health, Safety and Communication

Let us know if there is anything we can pray for you about None Yes, I have a prayer request

Additional Notes You Would Like Us to Be Aware Of None Yes, I have additional notes

Will Need Medication Administered During Event? * Yes No

* Please note that the host organization, their staff and volunteers are not responsible for administering medication to guests during the event. If medication is required during the event, a parent or caretaker MUST be available to administer the medication.

Food Needs (food cut-up, gluten free, dairy free, nut free, etc.)? * None Yes, has food needs

Allergies: list any that apply (foods, animals, latex, makeup, plants, pollen, etc.) * None Yes, has allergies

Sensory concerns: (e.g., elopement, strobe lights, camera flashes, loud noises) * None Yes, has sensory concerns

Special communication needs * None Yes, has communication needs

Fun fact about your guest * None / Prefer not to share Yes, I have a fun fact to share

5. Event Day Plans

Wheelchair or accessibility device dependent * Yes No

How will the guest be transported? * Transported by Parent/Caretaker. Transported by Group Home.

First and Last Name of Buddy Request (If possible) No specific request Yes, I have a buddy request

6. Respite Room

If enjoying Respite Room, please list up to 2 Parents or Caregivers

Name 1

Attending the Respite Room Wants to volunteer for the event instead

*The Respite Room is a private area where parents/caretakers of guests can spend the evening enjoying food, entertainment, activities, and rest while remaining onsite during the event.

7. Care Provider/Group Agency Information

Will the Guest be with a Group Agency During the Event? * Yes No

(MUST be 18 Years or older) I have read and agree to this waiver. *

By typing your name below you are agreeing to the above. Under 18 requires care provider permission. A care provider must sign below. *