Participant & Family Registration Form There was an error trying to submit your form. Please try again. Participant's First Name * This field is required. Participant's Last Name * This field is required. Preferred Name/Nickname This field is required. Gender Select an option Male Female Non-binary / Gender Diverse Prefer Not to Say Age * Select an option 18-24 25-34 35-44 45-54 55+ This field is required. City of Residence * Issaquah Bellevue Carnation Duvall Fall City Kirkland Mercer Island Newcastle North Bend Redmond Renton Sammamish Snoqualmie Other This field is required. School/Program Currently Attending (Optional) Any current school or program attendance. This field is required. Parent/Guardian/Caregiver Name(s) * Who will accompany the participant to and during the event? This field is required. Relationship to Participant * What is your relationship to the participant? Select an option Parent Guardian Caregiver Support Person Family Member Other This field is required. Phone Number * Best number to reach you. This field is required. Email * Your email address. This field is required. Preferred Communication Method * How do you prefer to be contacted? Text Email Phone This field is required. Is the parent/guardian/caregiver listed above also the emergency contact? * Select an option Yes No This field is required. If not, please provide the emergency contact person's full name and phone number. This field is required. Anything You Would Like Us to Know to Better Support Them? (Optional) Accommodations, Support Needs, or Allergies Program Interests * Select all that apply. Weekly Wednesday Social Gatherings Monthly Sunday Community Events Arts & Music Community Outings Family Events Recreation & Wellness Life Skills Activities Future Respite/Support Programs All of the Above Not Sure Yet This field is required. Participant Acknowledgement, Assumption of Risk, and Liability Release Please read and acknowledge the terms. I have read, understand and agree to the Participant Acknowledgement, Assumption of Risk, and Liability Release above. * This field is required. Submit There was an error trying to submit your form. Please try again.
