Movement Defense Clinic - Participant Form

Name of organization

Person of contact

Enter the name of who will be the person to correspond with on behalf of your organization

First Name

Last Name

Email

How many people from your organization are attending?

Attendee Names

Accessibility Needs

Sign-language

Scent needs

Special food needs

Translation needs

Other access needs

Scent need details

Fragrance-free

Reduced scent

Food need details

Language(s) needed

Other access needs

Do you need childcare?

Yes

No

For each child, please provide: 1. Name 2. Age 3. Food restrictions 4. If toilet trained or not 5. Guardian's name & contact

Transportation Needs

We can arrange transportation for all our members

Some of our members require transportation that we cannot provide (please detail below)

Please provide: 1. Names/contact info 2. Which day rides are needed 3. To/from venue or both

Submit