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Home
About
Staff
What’s Happening
Thank You!
Parents
Gallery
Volunteer
Active Volunteer Page
Supporters
Contact
Menu
Home
About
Staff
What’s Happening
Thank You!
Parents
Gallery
Volunteer
Active Volunteer Page
Supporters
Contact
Facebook
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Donate
Registration form 4 – Non-life-threatening Medical information
Other Medical information
Please indicate any of the following which apply
Allergies (non life-threatening)
Yes
Please explain
(Required)
Arthritis
Yes
Please explain
(Required)
Cardiac Conditions
Yes
Please explain
(Required)
Chokes Easily
Yes
Please explain
(Required)
Circulatory Problems
Yes
Please explain
(Required)
Dentures
Yes
Please explain
(Required)
Diabetic
Yes
Please explain
(Required)
Epilepsy
Yes
Please explain
(Required)
Fear (water, animals, etc.)
Yes
Please explain
(Required)
Hearing Loss
Yes
Please explain
(Required)
Hepatitis B Carrier
Yes
Please explain
(Required)
IBS
Yes
Please explain
(Required)
Psychiatric Illness
Yes
Please explain
(Required)
Respiratory Problems
Yes
Please explain
(Required)
Seizures
Yes
Please explain
(Required)
Special Diet
Yes
Please explain
(Required)
Stomach Problems
Yes
Please explain
(Required)
Wears Glasses or Contacts
Yes
Please explain
(Required)
Wears Braces/Special Shoes
Yes
Please explain
(Required)
Uses Alternative Communication
Yes
Please explain
(Required)
Participant Diagnosis
Please provide a detailed description and any other information that would help us understand your participant's needs.
