Fill out the Registration!

Fall 2019 Youth Registration Form
  1. (required)
  2. (required)
  3. (required)
  4. Will anyone accompany this participant during RADD activities?
  5. Will a Service Animal accompany this participant during RADD activities?
  6. Contact:


  7. (required)
  8. (required)
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  10. (required)
  11. (required)
  12. (required)
  13. (valid email required)
  14. Prefer Contact by


  15. Party Responsible for Payment

  16. (required)
  17. (required)
  18. Youth Overnight Respites:





  19. Kids Swim and Zumba

  20. Six Hour Youth Day Respites






  21. Christmas Party December 15th 12 to 3 ||