Semi Formal Registration Form - Lola’s Roundtable

Email

This field is for validation purposes and should be left unchanged.

Buddy

A buddy serves as a supportive companion for an individual who might not have someone attending with them.

The buddy’s role includes:

Helping the individual navigate the event, such as locating the bathroom or finding their assigned table.
Encouraging them to participate in activities, like dancing or engaging with others, to ensure
Keeping an eye on their well-being throughout the event, including checking on their comfort and ensuring they remain in good health.
Assisting with practical needs, like making sure they receive the proper dinner or any dietary accommodations they may require.

The buddy is there to ensure the individual feels cared for and has a positive, stress-free experience.

Guardian/Caregiver Contact Information

Phone(Required)

Email(Required)

Company Name

Please list the attending caregiver/support worker's dietary restrictions:(Required)

Attendee Information

Attendee Age(Required)

Behavioural Information

Please explain physical behaviours:(Required)

Please explain verbal behaviours:(Required)

Please explain flight risk:(Required)

Mobility Information

Wheelchair(Required)

Please provide more details and specify type of chair below (ex. push chair / electric chair, etc).

Other(Required)

Please provide details below:

Vision and Auditory

Visually Impaired (Requires Guidance)(Required)

Please provide details below:

Hearing Impaired (Requires Guidance)(Required)

Please provide details below:

Communication

Communication Expressive(Required)

How does your family member communicate to others, ex. verbal, sign language etc? Please provide details below:

Communication Expressive(Required)

How does your family member communicate to others, ex. verbal, sign language etc? Please provide details below:

Communication Receptive(Required)

How does your family member receive communication from others? Provide details below:

Dietary

Requires Assistance(Required)

Please provide assistance details below:

Allergies(Required)

List allergies below:

Dietary Restrictions (Dislikes / Should Not Have)(Required)

Provide dietary restrictions details below:

Purée / Minced(Required)

Please explain texture below:

Getting Ready

Table Seating

Names of attendees your family member would like to sit with:(Required)

Please enter any names of attendees your family member would like to be sat with. If names aren't provided, your family member may not end up at a table with friends.

Ticket Purchase

Attendee Ticket

Price:

Caregiver/Support Worker Ticket

Price:

Purchase Ticket Options

Credit Card Information

*Please send E-Transfer to semiformal@lolasroundtable.com.

Cash can be delivered to:

Lola's Roundtable
69 Talbot St N, Essex, ON
*Can leave in mailbox with name of attendees

Total Amount:

Email address to send receipt to(Required)

6 + 3 =(Required)

(After entering the correct answer in the box above, the Submit button will appear.)

Semi Formal Registration

Register an Individual for Semi Formal

Buddy

Guardian/Caregiver Contact Information

Attendee Information

Behavioural Information

Mobility Information

Vision and Auditory

Communication

Dietary

Getting Ready

Table Seating

Ticket Purchase

Purchase Ticket Options

Contact Us

Payment Methods

Additional Info

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