Long Island WTC Responder Family Picnic
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1. Registration Form
Welcome to the first annual Long Island World Trade Center Responder Family Picnic.
Please fill out this registration form to help us prepare for this exciting event.
*
1
. First Name:
First Name:
*
2
. Last Name:
Last Name:
*
3
. Occupation/Role during your response to 9/11
Occupation/Role during your response to 9/11
*
4
. How many people will attend the picnic?
1
2
3
4
5
6+
How many people will attend the picnic?
*
5
. How many of those attending are children?
Number of children
Ages 0-3
0
1
2
3
4+
How many of those attending are children? Ages 0-3 Number of children
Ages 3-7
0
1
2
3
4+
Ages 3-7 Number of children
Ages 7-11
0
1
2
3
4+
Ages 7-11 Number of children
Ages 11+
0
1
2
3
4+
Ages 11+ Number of children
6
. If you have children, please select all the activities that you would like to see at the picnic. (You may select multiple answers)
If you have children, please select all the activities that you would like to see at the picnic. (You may select multiple answers)
Soccer activities
Baseball/Softball activities
Football activities
Obstacle Course
Facepainting
Arts and Crafts
A firetruck to play on
Other
Please enter other activity suggestions here:
7
. Please select all activities that YOU would like to see at the picnic. (You may select more than one answer)
Please select all activities that YOU would like to see at the picnic. (You may select more than one answer)
Dancing
Soccer activities
Volleyball activities
Baseball/Softball activities
Football activities
Tug of War
Other
Please enter other activity suggestions here:
8
. Please provide us with your email so we can update you about the picnic.
Please provide us with your email so we can update you about the picnic.
9
. Since we anticipate a large number of people at the picnic, and because there will be children at the event, please supply us with an emergency contact and their number for the day of the picnic (August 29).
Since we anticipate a large number of people at the picnic, and because there will be children at the event, please supply us with an emergency contact and their number for the day of the picnic (August 29).
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