Select State
Alabama
Alaska
Arizona
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California
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Connecticut
District of Columbia
Delaware
Florida
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Hawaii
Idaho
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Indiana
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Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Select State
Select Age of child in therapy
Less than 5 years old
Between 6-13 years old
More than 13 years old
Age of child in therapy
Volunteering to assemble NICU donation giftbags 1 hour prior to the retreat (no cost)
Participating in a social event off-site after the retreat with other parents (at my own cost)
Going out to dinner with other parents at a nearby restaurant (at my own cost)
Staying overnight after the retreat at a nearby hotel with rooms reserved for CITY parents (at my own cost)
None of the above
Select Are you currently listed in CITY's Directory?
No, I will need to create a listing.
Yes, but I need to update my listing.
Yes, I am listed and my information is up-to-date.
Are you currently listed in CITY's Directory?
Select Are you interested in corporate sponsorships?
Yes, please contact me regarding corporate sponsorship options.
Yes, let's connect, as I have a contact who might be interested.
Not at this time, but I will keep this option in mind.
Are you interested in corporate sponsorships?
Select Are you registering as part of a group?
Yes
Are you registering as part of a group?
Select Choice of Movie
Monsters, Inc.
Hocus Pocus
Harry Potter and the Sorcerer's Stone
Choice of Movie
Monday, 12/16 from 9:00am-12:00pm
Monday, 12/16 from 12:00pm-3:00pm
Monday, 12/16 from 3:00pm-6:00pm
Tuesday, 11/26 from 6:00pm-8:00pm
Tuesday, 12/3 from 6:00pm-8:00pm
Tuesday, 12/10 from 6:00pm-8:00pm
Select Contact List
I DO want to have my name & email included on the contact list that attendees will receive at the retreat.
I do NOT want to have my name & email included on the contact list that attendees will receive at the retreat.
Contact List
Select Contact List
Please include my email on the contact list provided to all guests.
Please do NOT include my email on the contact list provided to all guests.
Contact List
Wednesday, 12/11
Thursday, 12/12
Friday, 12/13
Saturday, 12/14
Sunday, 12/15
Monday, 12/16
Day of Sale on Friday, 12/13 from 9:00am-12:00pm
Day of Sale on Friday, 12/13 from 12:00pm-3:00pm
Day of Sale on Friday, 12/13 from 3:00pm-6:00pm
Day of Sale on Friday, 12/13 from 6:00pm-9:00pm
Day of Sale on Saturday, 12/14 from 9:00am-12:00pm
Day of Sale on Saturday, 12/14 from 12:00pm-3:00pm
Day of Sale on Saturday, 12/14 from 3:00pm-6:00pm
Day of Sale on Saturday, 12/14 from 6:00pm-9:00pm
Day of Sale on Sunday, 12/15 from 9:00am-12:00pm
Day of Sale on Sunday, 12/15 from 12:00pm-3:00pm
Day of Sale on Sunday, 12/15 from 3:00pm-6:00pm
Select Do you have an in-kind donation to contribute?
Yes, please contact me to arrange pick-up of this giveaway prize.
I do not have a prize to donate, but I can put you in touch with someone who may be interested.
Not at this time, but I will keep this option in mind.
Do you have an in-kind donation to contribute?
I am a current volunteer with CITY of Support.
I heard about CITY of Support from a friend.
I heard about CITY of Support through my school.
I heard about CITY of Support from my family.
I heard about CITY of Support through social media.
I heard about CITY of Support through my community connections.
Select How will you be participating?
I am signing up as an individual bowler and will be placed on a team.
I am signing up with a group of bowlers who will make up our own team. (Maximum of 5 bowlers per team.)
How will you be participating?
I will drop them off at a public donation Collection Site.
I will drop them off during Community Drop-Off Hours.
Please send me a red bag, so I can be listed as a public Collection Site.
Please send me a red bag, so I can collect private donations from my own contacts.
Select How will you receive your CITY Sensory Break Box?
I will pick it up at the Parent Retreat.
I will pick it up from the Buffalo Grove location.
I will have it shipped to me at an additional cost.
How will you receive your CITY Sensory Break Box?
Select Is your Santa Site open to the public?
Yes, please share my address on the website
No, I will coordinate my own collection
Is your Santa Site open to the public?
Select Name of Graduating Class
C.I.T.Y. of Support (rainbow)
In2Great! Pediatric Therapy (yellow)
Marissa Bennett Consulting (green)
Roots Autism Solutions & Therapeutic Academy (turquoise)
Caravel Autism Health (royal blue)
Key Autism Services (navy)
Comprehensive Behavior Development (purple)
Name of Graduating Class
Select Preferred GROUP Start Time: Virtual Game Night
6:00pm
7:00pm
8:00pm
Preferred GROUP Start Time: Virtual Game Night
Select Preferred Start Time: Live, Virtual Game Night
6:00pm
7:00pm
8:00pm
We'd prefer a puzzle instead.
Preferred Start Time: Live, Virtual Game Night
Select Procession Arrival Time
9:15
9:30
9:45
10:15
10:30
10:45
11:00
11:15
11:30
12:15 (Drive Thru)
Procession Arrival Time
Wednesday, 12/11 from 9:00am-12:00pm
Wednesday, 12/12 from 12:00pm-3:00pm
Wednesday, 12/11 from 3:00pm-6:00pm
Thursday, 12/12 from 9:00am-12:00pm
Thursday, 12/12 from 12:00pm-3:00pm
Thursday, 12/12 from 3:00pm-6:00pm
Select T-Shirt Size
X-Small
Small
Medium
Large
X-Large
2X Large
I do not wish to receive a t-shirt. Please donate the proceeds back to C.I.T.Y.
T-Shirt Size