PIF
  • 2026 Participant Information Form

  • Participant's Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  •  - -
  • Gender*
  • Living Situation*
  • Format: (000) 000-0000.
  • Emergency Contact

    Person to be contacted FIRST in an emergency.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Cancellation Contact

    Person to be contacted when a SOAR Activity is CANCELLED
  • Format: (000) 000-0000.
  • Guardian & Payee Information

  • Guardianship*
  • Format: (000) 000-0000.
  • I have Long-Term Care Funds (select one if applicable)
  • Format: (000) 000-0000.
  • Medical Conditions

  • Check ALL that apply:*
  • Is there anything we should know about the person's
  • Does this person have a diet restriction or limited intake?*
  • NOTE: If this person has severe diet restrictions, we recommend that you send a bag lunch along.

  • Does participant respond independently to emergency situations (such as fire alarms/drills)?
  • For agency funding/reporting purposes, the following information is needed:

    No names are shared.
  • Race
  • Ethnicity (Choose one if applicable)
  • Gender Identity (Choose those applicable)
  • INDIVIDUAL Participant Income Level (not Family)
  • Notices & Release of Liability

    SOAR Fox Cities, Inc. and its programs are not responsible for accidents or injuries that may occur ot participants or attendess during activities.  SOAR Fox Cities, Inc., its employees and volunteers are not liable for any and all claims demands, losses, damages, actions, rights of action of whatever kind or nature arising out of, in consequence of, or on account of any injuries or incidents which may occur due to participation in a SOAR actvity.

    By typing my name in the indicated fields, I hereby certify that all of the information submitted in this form is true, accurate and complete. I understand that transactions and/or signatures in records may not be denied legal effect solely because they are conducted, executed, or prepared in electronic form, and that if a law requires a record or signature to be in writing, an electronic record or signature satisfies that requirement. I further understand that false statements made knowingly and willfully on this form are punishable by fine and/or imprisonment under the provisions of 16 U.S.C. §1857 and 18 U.S.C. §1001.

  • YES! I want to receive the monthly member newsletter from SOAR Fox Cities!
  • YES! I want to receive fundraising communication from SOAR Fox Cities!
  • Should be Empty: