Spotlight Abilities Questionnaire

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Spotlight Abilities Theater Camp Questionnaire

Spotlight Abilities Theater Camp and Class Health Questionnaire

Participant Name(Required)

First Last

Participant Preferred Name (if different than given name)

Date of Birth(Required)

Name of Parent/Guardian(Required)

First Last

Name of Parent/Guardian

First Last

Parent/Guardian Phone(Required)

Parent/Guaridan Email(Required)

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

List Allergies

History of Seizures

Sensory Concerns

Explain Sensory Concerns if Yes

Hearing Concerns

Explain Hearing Concerns if Yes

Visual Concerns

Explain Visual Assistance Needed if Yes

Explain Hearing Concerns if Yes

Physical Assistance Needed

Uses Bathroom Independently

Emotional Assistance Needed

Explain Emotional Assistance Needed if Yes

Provide Any Information Necessary to Make This The Best Experience for Your Participant