Please complete all required fields!
This enrollment form consists of 5 pages and should take 15 minutes or so to complete. Please have the guest's medical information (doctor, insurance, allergies) and emergency contact information handy.
When you're done, don't forget to use the "Submit" button on the last page to send your information.
Able to communicate independently
Some verbal communication
Uses signs, gestures, or other non-verbal methods
Other (please explain)
Requires some assistance
Special dining considerations (please explain)
Requires some assistance (please explain)
Will require staff person to keep individual's money, assist with purchases, and account for money.