D&B Participant Registration (2024)
Thank you for joining us for Snorkel Day! This form is good for the 2024 calendar year.
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Snorkel Day Location *
Full Name
Birth date *
MM
/
DD
/
YYYY
Address *
Phone number *
Email *
Residency *
Ethnicity (One or more categories may be selected) *
Required
I will be attending the event with the following group: (e.g. Private Home/ UofN/ Full Life) *
Please list the caregiver(s) here with you today:
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