1.1 Anchorage Program Participant Information Form


This is the general form for all participants. If you are the guardian of an adult please select Adult below and enter the participant's information. We will need a copy of the paperwork from the courts as well.

If completing for a child then select that option. 

Who will be participating?

Adult    Children

Signee Information


Seizures, bee allergy, diabetes, etc


Please complete if you are a veteran of the Armed Forces.

If rating from VA is pending or if still active duty please state that above

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.