Warrior's Name *

First Name

Last Name

Does your warrior have siblings? *

No

Yes

What types of activities would you be interested in? *

What are you hoping to find in this community space? (You can choose more than one)

Arts & crafts

Movie viewings

Interactive classes

Game nights

Sibling specific events

Parent specific events

Parent's Night Out

Other

What hours would you want to be in the Sprinkle Room? *

To give us an idea of when to plan activities (you can choose more than one)

Week days

Week nights

Weekend days

Weekend nights

How often would you like to go to the Sprinkle Room?

We just want an idea of how often we need to host!

Once a month

Twice a month

Every week

Would you need transportation? *

No

Yes

Caretaker's Info: *

First Name

Last Name

Phone *

(###)

###

####

Would you be interested in joining our parent ambassador group? *

Let's talk about how you can be involved in our organization, connect with other parents who are facing similar situations, and be part of building a community rooted in positivity and support.

No

Yes

Permissions *

I grant OPP my permission to use any photographs or videos that I, the parent/guardian of the child above, provide to Oliver Patch Project (OPP) described for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. We respect and value your privacy; if photos of your child are used as part of any Oliver Patch Project Campaign, only their first name will be noted.