5/6/2020 Confidence N' Chemo

Con dence N' Chemo

Please fill out the questionnaire below, feel free to write any questions, concerns or additional
information at the end.
* Required

1. Will you be attending the Confidence N' Chemo event on March 21, 2020 from 2pm-
6pm? *

Mark only one oval.

Yes

No

Attendee Information

2. What is the name of the child? *

3. How many people (including the child) will be attending? *

Please include names and ages (of children only)

4. Are you/your child willing to get your picture taken by me to be put on a website only
seen by myself and the Westerly Senior Project judges? *

Mark only one oval.

Yes

No

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5/6/2020 Confidence N' Chemo

5. How old is the child attending? *

6. What activities would you like to see at the event?

7. Does the child have any diet restrictions/ allergies/ medical restrictions? *

8. Please list any questions, concerns, or additional information I should know below!

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 Forms

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