Reconnect Gaming Intake Form

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(Fill out this form if you are interested in having Reconnect Gaming come to your facility!)

Reconnect Gaming visits establishments to bring gaming to individuals!
Reconnect Gaming ONLY visit on the weekends.
We bring everything needed to game to the people, in hopes to help them reconnect their life with healthy outlets.

If you have any direct questions please email: info@reconnectgaming.org

Soft Opening this January 2024

Email *

Record my email address with my response

1. What establishment do you run? *

Rehabilitation Center

School System

Private Business/Organization

Other

2. What is the name of your establishment? *

3. What is the address of your establishment? *

4. How many people from your establishment would try our mobile gaming lab? *

1-5 people

6-10 people

11-15 people

16-20 people

Submit

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