Forms • Fair Oaks Recreation & Park District, CA • CivicEnga

Intake Form

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Registrant's Name*

Contact Person*

Phone Number*

Email *

Course Name

What type of accommodation would allow you to best participate in the program?*

Has the participant had seizures in the past? *

Yes

If yes please indicate the type and describe any potential trigger for seizures (if known)

* indicates required fields.