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REAL - Participant Registration Form

Steps

  1. 1. REAL Participant Registration Form
  2. 2. INDIVIDUAL NEEDS
  3. 3. Release and Acceptance
  • REAL Participant Registration Form

    1. Real.jpg

    2. Participant Registration Form

      ALL areas of Registration form MUST be complete to Participate (Photo release optional) Information included in this form will remain confidential and will be used solely to benefit the participant. *For any item marked with an asterisk, please contact us ahead of your first activity so we are sure to have enough staff on hand to meet your needs. Thanks!

    3. Is the participant under the age of 21?*

    4. Does the participant live in Douglas County?*

    5. Please include additional email addresses you wish to add to the REAL contact list.

    6. Who does the participant live with:

      Check all that apply.

    7. LEGAL GAURDIAN

      *In Colorado, a person becomes emancipated at age 18, regardless of disability. Parents may seek guardianship through the court system to maintain personal, medical, and limited financial decision-making responsibilities beyond age 18.

    8. Who has guardianship for above-named participant?

      (Check all that apply)

    9. (optional)

    10. (optional)

    11. (In the event Parent/Guardian cannot be reached)

    12. Emergency contact is authorized to pick participant up?*

    13. PICK UP AND DROP OFF

      In order to ensure safety of all participants, we require a parent/guardian to sign in and sign out any participant who is under 10 years old or who is not his/her own guardian.

    14. Is there anyone who should not be allowed to pick up participant?

    15. PERSONALITY

      Knowing a little bit about each participant can help us provide the best experience and level of support needed.

    16. What recreation and leisure activities does participant enjoy?

      (check all that apply)

    17. We want to know what else you like to do. Let us know below. Share your ideas!

    18. (optional)

    19. (optional)

    20. AVAILABILITY

    21. When would you prefer to attend activities?