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Randolph County's Greatest Show
Due June 30th
Show July 17
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Name of Participant
Your answer
Name of Parent/Guardian
Your answer
Grade/Age of Participant
Your answer
Phone Number (best contact)
Your answer
Email (best contact)
Your answer
Participant T-shirt Size
Child S
Child M
Child L
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Other:
Clear selection
Nature of Disability (please be as specific so we can best serve the participant)
Your answer
Does the participant use a walker, wheelchair, or crutches?
Yes- Wheelchair
Yes- Crutches
No
Other:
Clear selection
Does the participant have any allergies? If so explain
Your answer
Is there anything else we should know?
Your answer
Emergency Contact- Name and Phone Number
Your answer
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