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#GameOn Autism® Golf Clinic Registration

Which regional Golf Challenge event are you attending?(Required)

Participant's Name(Required)

MM slash DD slash YYYY

Participant is:(Required)

Participant's golf skill level:(Required)

Participant communicates:(Required)

Participant's receptive language capability:(Required)

Parent/Guardian's Name(Required)

RELEASE, WAIVER OF LIABILITY And ASSUMPTION OF RISK(Required)

VIDEOGRAPHY/PHOTOGRAPHY/AUDIO RELEASE CONSENT

VIDEOGRAPHY/PHOTOGRAPHY/AUDIO RELEASE CONSENT

Please choose one:(Required)
Employees/staff/Contractors of the Els for Autism Foundation may use these photographic images, video segments, or audio segments for reasons other than therapeutic purposes, including dissemination on social media.

Please choose one:(Required)

Please choose one:(Required)

Please choose one:(Required)

If you have further questions about the information on this form, you may contact info@e4agolf.com.