LAX-ABLED CLINIC REGISTRATION

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Please complete the registration below. ALL SESSIONS FREE! If you plan on registering for the subsequent 4 sessions (free), please use this form: https://forms.gle/H1EXLUkkyDSRAxYM7
The registration includes a t-shirt and water/snacks. All equipment will be provided on-site.
Registration closes May 27, 2022- spots are limited.

Email *

Participant First Name: *

Participant Last Name: *

Gender *

Male

Female

Prefer not to say

Other:

Date of Birth *

YYYY

Grade as of 2021-2022 school year *

Home Address *

Zip Code *

Mailing Address (If Different Then Home)

Parent/Guardian Full Name *

Parent/Guardian Phone Number (Best Contact) *

Parent/Guardian Email *

Parent/Guardian #2 Full Name

Parent/Guardian #2 Phone Number (Best Contact)

Parent/Guardian #2 Email

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