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Down to Box Registration Form

Down to Box is held at Knockout Boxing 1244 Capitol Trail Newark DE 19711 every Tuesday night from 6:30-7:30pm and is for individuals with Down syndrome or other intellectual and developmental disabilities ages 13+.

The cost to attend is $75 per session. Upon submission, DSA of Delaware will invoice you for the session. If you would prefer to pay by credit card, there will be a payment link on the next page (once you submit this form).

Please complete the following registration form to reserve your spot in Down to Box.

Missed the deadline but still want to participate? You can still sign up! Your fee will be pro-rated for the time you sign up.

Questions? Contact Nancy at office@dsadelaware.org. Thank you!

Participant Contact Information

Participant Name

First Name

Last Name

Participant Email

Verify Email

Participant Phone

Participant Date of Birth

(mm/dd/yyyy)

Does the participant have Down syndrome?

Yes

What condition does the participant have?

Are there any health or behavioral concerns for the participant that we need keep in mind?

Please provide the following information for TWO adult support contacts.

Adult Support Contact 1

Support Contact 1 Name

First Name

Last Name

Support Contact 1 Email

Verify Email

Support Contact 1 Phone

Type of Adult Support

Parent

Guardian

Other Support Person

Adult Support Contact 2

Support Contact 2 Name

First Name

Last Name

Support Contact 2 Email

Verify Email

Support Contact 2 Phone

Type of Adult Support

Parent

Guardian

Other Support Person

I understand by clicking SUBMIT I am registering for Down to Box and will be invoiced upon completion of this form.

Yes, I understand.