Camp Questionnaire

Training Camp Questionnaire

* Indicates required field

Service Dog Recipient Name *

First

Last

Name of Care Attendant (if applicable) *

First

Last

Name of any additional care attendants attending camp on your behalf (if applicable) *

Email *

TRANSPORTATION

Are you: *

MEDICAL NEEDS

Will you be bringing: *

Do you have heat/cold sensitivities? *

Yes No

If you have seizures, do flashing lights or strobe lights cause you distress? *

Yes No

If there additional medical needs we need to be aware of, please list below. *

Submit