Adventure Island Playground Anniversary Booth Registration form

Tables, chairs, and tablecloths will be provided. We have space for approximately 40 booths for businesses or organizations that support families and children who have disabilities.

We ask that you plan to have an activity and/or fun giveaways for children of all ages and abilities, however per our agreement with the City of Meridian, we are not allowing sales of products or food.

Information About You

Are you a:

ParentProfessional

First Name:

Last Name:

Demographics:

Ethnicity:

Hispanic or LatinoNon-Hispanic or Non-LatinoOther

Phone Number:

Email Address:

Join Mailing List

If you would like to be on IPUL's mailing list check this box.

Mailing Address

Mailing City

Mailing State

Zip Code

This address is my

HomeWork

Be On the Fridge Magnet!

We are preparing a Map to Services Fridge Magnet - for attendees of the Adventure Island Celebration.

Register by July 24th in order to be included on the magnet -- We also need to know specifically how you would like your contact information to be listed on the magnet.

Please let us know the following information: Your Organization or Resource's Name, and then at least one of the following: The URL from your website (Or your main social media platform - whatever you use primarily) and then either your phone number or organization's email address. This is so people can use the magnet to contact you.

We need the name you want on the magnet and at least one of those three methods to contact you - a Link to a web resource, phone number, or email address. All three are also just fine.

Organization Name:

Website / Main social media platform:

Phone Number:

Email Address:

Professional Information

Organization Name:

My Title:

Phone Number:

Only if different from above

Email Address:

Only if different from above

Information About Your Child

Please only enter information for an individual child, you will be able to add more children below.

Child's First Name:

Child's Last Name:

Child's Gender:

FemaleMale

Child's Birthdate:

Child's Demographics:

Child's Ethnicity:

Hispanic or LatinoNon-Hispanic or Non-LatinoOther

Child's Diagnosis:

Do You Have Another Child to Enter?

YesNo

Information About Your Child (2)

Please only enter information for an individual child, you will be able to add more children below.

Child 2's First Name:

Child 2's Last Name:

Child 2's Gender:

FemaleMale

Child 2's Birthdate:

Child 2's Demographics:

Child 2's Ethnicity:

Hispanic or LatinoNon-Hispanic or Non-LatinoOther

Child 2's Diagnosis:

Do You Have Another Child to Enter?

YesNo

Information About Your Child (3)

Please only enter information for an individual child, you will be able to add more children below.

Child 3's First Name:

Child 3's Last Name:

Child 3's Gender:

FemaleMale

Child 3's Birthdate:

Child 3's Demographics:

Child 3's Ethnicity:

Hispanic or LatinoNon-Hispanic or Non-LatinoOther

Child 3's Diagnosis:

If you have more than three children that you need assistance with, our Parent Education Coordinator will take your information directly.

I will be needing a booth as

A Standard Business ($100) A Non-Profit ($50)Other (Contact Us)

After registration is complete, you will be sent an email with a paypal link - your registration will be complete once you have paid. if you have any questions about your status at all please contact us at adventureIsland@ipulidaho.org

Event Information

Training Name

Incredibly Important Back End Stuff
(Hidden from person filling form, but needs to be set up when building the registration or everything will be for naught and you will spend several days trying to fix your data WITH WOE IN YOUR HEART AND A POX UPON YOUR HOUSE)

Funding Source

separate with semicolon and put in Default Value under Options
EXAMPLE:
MCHB F2FHIC; PTI

(THESE NEED TO MATCH SALESFORCE OR PAIN WILL RESULT)