Down Syndrome Association of Central New Jersey
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Events
Mid Day Open Play
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9/7/2024
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REGISTER FOR IN PERSON HERE
REGISTER FOR IN PERSON HERE
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To allow us to continue to understand and adapt to the needs and barriers of our participants we ask you to consider answering the following optional demographic data collection questions. As a nonprofit, grant support is a large percent of our funding and this demographic data is key to grant requests.
Race
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Primary language spoken at home
Does your family experience economic hardship?
Yes
No
Does your family experience transportation difficulties or lack of access?
Yes
No
First Name*
Last Name*
Email*
Phone*
Age
Address
How many participants will be attending?
Please pay below with purchase of tickets for all attending if this is a paid program.
Do you permit photos and allow Club DREAMS to utilize for marketing?*
Will you child need assistance in the bathroom? If so, do you permit Club DREAMS staff to assist?*
Allergies? Other things we should know?*
Provide Emergency contact number for 2 people.*
Are you planning on attending weekly or occasionally? If weekly please contact us if there is a week you are not attending, if sporadically you must register for each week attending.*
Please tell us about your child and how we can best support them.*
Does your child have Down Syndrome, Autism, other condition- please provide more info so we can best support your child.*
-Any member(s) under the age of 6 years old must have an adult accompany them at all times within the suite, with the exception of select designated times such as Kids Night Out events. Guardians may help themselves to refreshments and relaxation in the welcome area. -Any member(s) between the ages of 7-10 may be dropped off at the center, with the exception that an adult guardian must stay within the Suburban Square shopping plaza and can be reached immediately by phone if needed (with the exception of designated events such as Kids Night Out). -Member(s) ages 11+ may be dropped off at the center, and adult guardians must be able to be reached by phone if needed.*
How did you hear about us?*
Are you a DREAM team member? (DREAM team is a membership through which community members with special needs or siblings may participate in our programs even if they are not DSACNJ members). Not a DREAM team member but want to join? Click on the link above at the bottom of the program description.*
Are you participating in a program or event through our DREAM team membership?*
Best method to contact
Text
Email
Phone
Other
General Release Form*
Check the box to acknowledge and accept the General Liability Clause*
Read the detailed General Liability Clause
Your Name (Being served as a signature)*
Address
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