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Club Connect Intake Form
Club Connect is an all-abilities friendship club that meets most Thursdays from 6-7:30pm. If you are an individual or family interested in participating, please fill out the form below.
We are so excited about the possibility of you joining us!!!
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First and Last Name
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Your answer
Date of Birth
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YYYY
Email
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Your answer
Phone Number
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Your answer
Employer/Occupation
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Your answer
If you are currently a student, which school do you attend?
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Your answer
Tell us a little bit about yourself and why you are interested in Club Connect!
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Your answer
Do you see you or your loved one needing any extra support in order to be successful at Club Connect? If yes, please describe what this might look like.
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Your answer
How did you hear about Club Connect at Benjamin's Hope?
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Your answer
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