2012 Special Friend Registration

Child Information

Child's First Name *

Child's Last Name *

Child's Nick Name

Gender *

Birthday *

Height *

Weight *

T-Shirt Size *

Parent/Guardian Information

Parent's First Name *

Parent's Last Name *

Parent's Relationship to Participant *

Phone Number (cell) * Your child's buddies will call you before the event to learn more about your child

Phone Number (home) *

Email Address * We will send you important information regarding the event via a valid email address

Street Address *

City *

State *

Zip Code *

Other Contact's First Name *

Other Contact's Last Name *

Other Contact's Relationship to Participant *

Phone Number *

Food and Information

Is there any specific information about eating that we should know about? *

What can we do to make your child feel more comfortable and have a more enjoyable experience? *

Are there any specific behavioral/sensory/medical conditions that should be brought to our attention? (Medications, allergies, etc.) * Please note we are unable to administer medications

If your child becomes over-stimulated, how do you suggest we react or handle the situation? *

Can your child use the restroom without assistance? Please describe the nature of the assistance needed. *

Comments/Suggestions? Do you have any suggestions for activities, games, etc. that you child may care to participate in?

Activities

Our pool will be open will your child able to swim? * We will provide any necessary swimming devices

Photo and Video will be taken at this event for historical purposes, May we photograph/take video of your child? * Photos and videos will be available from our facebook

Is your child comfortable using an elevator to access the upstairs facilities? *

Further Information PLEASE READ

Registration received via this online form must have a parent/guardian present at check in to complete the required waiver form. You may download the waiver form from our website, complete it, and bring it to the event for quicker check-in: www.montclair.edu/campusrec/SFD. Further, we will be conducting a training session in which your child's buddies will become familiar with your child. Someone will also contact you to discuss the information that will help us get to know your child better. The event is from 10am until 2pm on Sunday, December 9, 2012. We encourage drop off from 9:45am-10:15am and pick up from 1:45pm-2:00pm. Thank you for your participation! If you have any further questions please contact: (973) 655-5350 or email MSUspecialfriendsday@gmail.com

Montclair State University

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Child Information

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Activities

Further Information PLEASE READ

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