Please provide the email address associated with the Zoom account that will be used for Virtual Hangouts *
Your answer
Parent/Guardian's Email Address (if different than participant)
Your answer
Participant's First Name *
Your answer
Participant's Last Name *
Your answer
Participant's Phone Number
Your answer
Parent/Guardian's Phone Number *
Your answer
Participant's Birthday *
MM
/
DD
/
YYYY
Participant's Age *
Your answer
Participant's Mailing Address *
Your answer
Is the participant currently a student? *
If so, what is the name of the school/home school he/she attends?
Your answer
Is the participant currently employed? *
If so, where does the participant work and what does he/she do?
Your answer
What is the participant's disability diagnosis? *
Your answer
How does the participant best communicate? *
Required
Please tell us anything else that would be helpful to know regarding the participant's communication. *
Your answer
Have you participated with the Friendship Journey, Dylan's Wings of Change or Wings of Friendship before? *
If you have participated with us before, please share what you have been part of.
Your answer
How did you find out about Virtual Hangouts? *
Your answer
Please tell us any interests, passions and hobbies of the participant. *
Your answer
Please tell us anything that would be helpful to know regarding how we can best support the participant during Virtual Hangouts :) *
Your answer
Our Virtual Hangouts are currently accessed through Zoom. Does the participant have access to Zoom on a computer, laptop or tablet? *
By checking this box, I consent to a photo release with Wings of Friendship. I understand that Wings of Friendship (The Friendship Journey and Dylan's Wings of Change) may use screenshots or video clips from our virtual activities to share the fun with our followers and donors. *
Required
By checking this box, I understand that activities will take place virtually. I am responsible for my technology and my safety and will hold harmless The Friendship Journey, Dylan's Wings of Change and all associated individuals and entities. *
Required
By checking this box, I acknowledge that I am over 18 years of age or have completed this form with the consent of a parent/guardian who is over 18 years of age. *
Required
By signing up as a participant for Virtual Hangouts, I agree to uphold the values of Wings of Friendship and will be inclusive, compassionate and respectful. *
Required
A copy of your responses will be emailed to the address you provided.