Parent or Guardian
First Name
*
Last Name
EAST-2 Alliance would like to insure that no individual with a disability is excluded from the EAST events due to the absence of auxiliary aids and/or services. Special equipment and/or materials in alternate format may not be available unless specifically requested in advance.
What accommodations does this student use when in school?
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What accommodations does this student use when at home or in the community?
Will this student be accompanied by a personal attendant?
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yes
no
Does this student need wheelchair accessible transportation?
*
yes
no
Does this student use a scooter and or other device to assist with mobility?
*
yes
no
If this student is hearing impaired, will they need a translator?
*
yes
no
Please read the following statements and click the button if you agree.
I give my permission and agree to allow this student to participate in all activities of the EAST events he/she is enrolled in
*
yes
I am committed to seeing that this student attends all sessions of the EAST event he/she has enrolled in.
*
yes
I agree to allow school personnel to assist this student in completing any and all forms necessary for participation in EAST events.
*
yes
First Name
*
Last Name
*
Email
*
Date
*
Electronic Signature
*
