Guest Name * First Name Last Name Name as you would like to appear on name tag Date of Birth * MM DD YYYY Gender * Male Female Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Fun Fact About Guest * Emergency Contact * During the event First Name Last Name Emergency Contact Phone Number * (###) ### #### Would you like to have a buddy? * We would love to have someone hang out with each guest for the evening! This way you know all the in's and out's! This is recommended but not required. Yes No Health Concerns Wheelchair/Accessibility Device Dependent Special Communication Needs Yes No If Yes Please Explain Sensory Issues/Concerns Strobe Lights, Camera Flashes, Loud Noises, etc Allergies Foods, Animals, Latex, Makeup, Plants, etc Food Needs Cut-up, Pureed, Gluten Free, etc. If you plan on bringing your own food please let me know but we are happy to accommodate any needs. Bathroom Needs Parent/Caretaker Name(s) Parent/Caretaker Phone * (###) ### #### Will you be Enjoying The Respite Room? If Yes, How Many? The Respite Room is a space just for families/caregivers to relax and enjoy their evening. Additional Notes Or Concerns Thank you!
