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    1. How many people in your party attending?

    2. If this campaign is a physical event, the organization may need to contact you. Please provide your info below.

    Additional Info.

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    1. Please complete the following form.
      1. I have a child(ren) with hearing loss ages 0-3 / Tengo un hijo (s) con perdida de audicion (nacimiento - 3 años)
      2. I have a child(ren) with hearing loss ages 4-7 / Tengo un hijo (s) con perdida de audicion de edad 4-7 años
      3. I have a child(ren) with hearing loss ages 8-10 / Tengo un hijo (s) con perdida de audicion de edad 8-10 años
      4. I have a child(ren) with hearing loss ages 11-14 / Tengo un hijo (s) con perdidad de audicion de edad 11-14 años
      5. I have a child(ren) with hearing loss ages 15+ / Tengo un hijo (s) con perdida de audicion de edad 15 +
      6. What are the names and ages of your child(ren) with hearing loss? Please also include hearing siblings. / Cual es el(los) nombre y edad de su hijo con perdida de audicion? Incluye su hermanos. *
      7. What are you looking forward to with this Building Connections event? / Que esperas de este evento de creando conexiones?
      8. I need captioning. / Necesito subtítulos. *
      9. I need Spanish Translation. / Necesito traducción al español. *
      10. If you are an educator what is your profession? (SLP, Audiologist, DHH Specialist, AVT etc.) / Si eres educador, cual es tu profesión?

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    I authorize NO LIMITS THEATER GROUP, INC. (“No Limits”) and its successors,
    licensees, and assigns to make use of my appearance in No Limits Theater Group, Inc. for any
    and all publicity, advertising, and marketing materials (printed and/or online) including the
    No Limits Theater Group, Inc. website, playbill, press releases, newsletters, social media, and
    media venues including television, video, photography, e-blasts, e-news, recording,
    Internet, research and data collection, quotations and DVDs (“NL Materials”).
    I understand that programs offered by NO LIMITS THEATRE GROUP, INC., may be recorded and may contain audio & video interactions that include my student.
    I hereby agree that I, myself, my assignees, heirs, guardians and legal representative will
    not claim against, sue or attach the property of the instructors at No Limits Theater
    Group, Inc., for injury or damage resulting from my
    participation in any class or elective.


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