Adults with Disabilities & Seniors Day Registration Monday October 2, 2017 Raindate October 9, 2017


Contact Info:

Group Name:
Group Address:
Outing Coordinator:
Outing Leader:
Phone Number:
Best number to call you at if your event needs to be rescheduled:
Contact Email:
Best Time &
Way to Reach You:
Method of confirmation requested: Email     Phone

Tour Information:

Arrival Time:
Departure Time:
Eating Time:

Snack    Lunch    Dinner
Number of Clients:
Number of Staff:
Approx. Number in Wheelchairs:
Is a receipt required or desired: Yes   No
Number of Receipts: 1 per group
1 per client
1 per staff


How did you hear about this special event?
Have you visited us before?
Comments and/or questions:

Once your reservation is obtained, you will receive
an e-mail confirmation. If you don't hear from us within 2-3 days,
please give us a call at 920-691-6742.