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SILO Spring Wellness Event
This form is to register for the SILO Spring Wellness Event.
Event Address: 3253 Route 112 Building 10, Medford, NY 11763
Time: 11am-2pm
Date: May 8th, 2024
Please make sure to schedule your SCAT bus at least
5 days in advance
to the event date.
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What is your full name (first and last)?
Your answer
What is your phone number?
*
Your answer
What is your email address, if you have one?
Your answer
Do you have any food allergies? please check off all that apply. If none select no. If not stated put allergy under other.
*
Yes - dairy products includes milk, eggs and cheese
Yes - peanut butter or nuts
No
Other:
Required
Do you need any accommodations or assistance? please check off all that apply. If not stated include accommodation under other.
*
Assistance to restroom
Assistance to seat and table
Assistance with meal
Sign language interpreter
No accomdations/assistance
Other:
Required
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