Cane Quest 2023-24

Regional Collateral Order Form

Welcome to Cane Quest! Please complete the following form no later than 3 months before your regional date. Collateral forms will not be accepted after January 1^st for the 2023-2024 Cane Quest season. Once completed, the National Programs (NP) Team will follow up with you to distribute all of your Cane Quest collateral materials.

Thanks again for your continued support!

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GENERAL INFORMATION

Host Agency:

Other Event Hosts/ Sponsors, if applicable:

Address of Regional:

Address Line 1

City

State / Province / Region

Postal Code

Country

Name of Regional Coordinator (main contact):

First

Last

Phone

Select Your Intended Program

Single Day In-Person Program
Virtual Program

Date of Testing:

Additional Notes:

Are you accepting prizes from sponsors?

Note: We provide a variety of prizes to all regionals but only a select number of regionals get the assistive technology device prize as we have a limited number of devices.

PERMISSION FORM

Would you like to receive a customized electronic Permission Form?

Note: Many regionals have opted to use digital Permission Forms using platforms like Google Forms, WordPress and Survey Monkey to collect the permission form information. You must make sure you are asking all the questions listed on our standard form, no exceptions. If this is the case, please note this in the “Notes” section below. And select “NO” here.

What is your Permission Form due date?

Additional Notes: