Buddy Up! Registration - May 2023
Mondays 5:00pm-7:00pm
$25 per hour or $45 full 2 hour session 
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Participant Name *
Age *
Allergies/Medical: (Please list any medical conditions or related information the facilitator may need to know in case of emergency in the program. (Ex. Epi pens, medications, physical assistive device info etc.)
The participant will be:
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Additional Information: (Please list any other additional information regarding the participant the facilitator should know to ensure any sensitivities may be avoided during the program. (ex. loud noises, certain music, changes in schedule etc.)

Which days will the participant attend?  *
May 1
May 8
May 15
May 29
5:00pm-6:00pm
6:00pm-7:00pm
(Full 2 hour session) 5:00pm-7:00pm
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