Current/Returning Participants paying with cash, check, Sparc Credit

Important Note:
This form is for returning participants only that are paying with cash, check or Sparc credit. Otherwise please go back to New Participant Registration Form. Please fill in all required fields and any updates since the participant was last registered.   

RESPITE: Program(s) Enrollment:
NON-RESPITE: Program(s) Enrollment:
Payment Type:(Required)
*all payments must be made prior to the participant starting a program.
Has your contact information changed in the last 6 months?(Required)
Has your personal care information changed within the last 3 months?(Required)
(ie: Self Care Needs, Allergies, Adaptive Equipment, Seizures, Vision or Hearing)
(By typing your name above you are consenting to the terms)
PHOTO RELEASE: I electronically consent to the following permission for the participant being registered: * for paragraphs or video images to be used for educational use or promotion of SPARC.(Required)
(This section MUST be completed)
(By typing your name above you are consenting to the terms)