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Participation Intake Form - Confidential

TOWN OF AURORA COMMUNITY SERVICES - INCLUSION
Please fill out this intake form if you have a participant attending a Town of Aurora Recreation Program who has a disability or unique need.

Personal Information


 

Emergency Contact Information

Personal & Medical Information

Seizures (if applicable)

Does the participant have a seizure disorder?
 
Are seizures a common occurrence?
 
Are there any warning signs we should look out for?