Event Registration Form
Please register each participant separately. This ensures we provide every person the access they need.
Event type
Please select...
Virtual
Hybrid
In-Person
Collect Dietary Information
Collect Dietary Information
Affinity Group Registration
Affinity Group Registration
Affinity Group Name
Waitlist
Waitlist
Registration Closed
Registration Closed
Registration Closed Early?
Registration Closed Early
Event Short URL
Accessibility Features
Event Information
Event:
Time:
Location:
Hello! This event has ended, but we appreciate you checking it out! Please visit our calendar at
disabilityculturalcenter.org/calendar
for a list of our future offerings.
As always, please reach out to
access@disabilityculturalcenter.org
with any questions. We'd love to hear from you
Hello! Thank you for checking out our event. We have closed registration to ensure that we can meet all access requests. If you would still like to attend, please email
access@disabilityculturalcenter.org
. While we cannot promise additional attendees, we can often add folks after registration closes.
This event has reached capacity. You can still sign up and will be placed on a waitlist. DCC staff will contact you capacity opens up again.
First Name(s)
Last Name(s)
Email
Phone Number
Pronouns (select all that apply, if you like)
She, her, hers
He, him, his
They, them, theirs
Just use my name
My pronouns are
Will you be joining us
In person
Virtually
Not sure yet, will come in person if my body/mind allows for it!
Access needs (check all that apply)
ASL
A live captioner
Captions but auto-generated Zoom captions are acceptable
Audio description of visual materials
Additional
Please specify
Do you require outdoor seating in order to join us?
Yes
No
Prefer it but am flexible
Seating access (check all that apply)
I am a wheelchair user - I bring my own seating
I prefer to bring my own
I need a heavy duty chair that will allow me to put weight on it as I get up and down
I need a larger chair
I need a softer chair or cushions
I need a place to sit/lie on the ground
I need a place where I can stand and prefer not to be seated
Additional
Please specify
Dietary restrictions/allergies
Dairy-free
FODMAP intolerance
Gluten-free
Low sodium
Vegan
Vegetarian
Allergy (please specify)
Additional
Allergies
Please specify
Yes
It’s helpful for our programs and funding to understand demographics. Are you willing to share a bit about your background/identities?
I have previously attended a DCC event and provided my demographic information
Yes, I will share demographic information to support the DCC
No, I prefer not to share demographic information
Background and Identities
What is your relationship to San Francisco? Check all that apply.
I live in San Francisco
I work or go to school in San Francisco
I visit San Francisco often
I used to live in San Francisco
I have no meaningful relationship with San Francisco
Additional
Please specify
Race
Indigenous / Native American / American Indian / Alaska Native
Black / African American / African
Asian American
Latine / Latinx / Hispanic / Latin American
Middle Eastern / North African
Native Hawaiian / Pacific Islander
White / Caucasian / European American
Additional
Prefer not to say
Please specify
Gender (Please select the one that best fits)
Agender
Intersex
GenderExpansive/Nonbinary
Cis Man
Questioning
Trans woman
Trans man
Two Spirit
Cis Woman
Additional
Please specify
Sexual Orientation (Please select the one that best fits)
Asexual/Aromantic/Demisexual
Bisexual/Pansexual
Gay/Lesbian
Queer
Questioning
Straight/Heterosexual
Additional
Please specify
Birth year
How would you describe your finances?
Struggling to make it work
Meeting basic needs
Meeting basic needs with a little extra
Comfortable with some disposable income
Financially thriving with lots to spare
Prefer not to share
Check all conditions that you currently experience:
Blind / low vision
Chronic Illness (HIV/AIDS, Cancer, MCS, MS, etc.)
Chronic pain
Deaf / Hard of Hearing
Intellectual / developmental disability
Large size / fat
Learning disability (dyslexia, dyscalculia, dysgraphia, etc.)
Limb difference / amputee
Little person / short stature
Mental health condition (anxiety, depression, schizophrenia,
bipolar, PTSD, etc.)
Mobility disability
Neurodivergent (ADHD, memory loss, autistic, TBI, OCD, etc.)
Substance abuse/addiction
Additional
Please specify
Consent to Share Information
Do you agree to the following terms?
The San Francisco Disability Cultural Center, a project of L.C. and Lillie Cox Haven of Hope ("HoH"), works in partnership with the City and County of San Francisco. By submitting this information, you consent to these three entities publicly sharing this information without any personal identifying information. Your name, contact information, and all other potentially identifying information are for HoH and DCC internal use only. This potentially identifying information will never be shared with third parties, unless required by law.
Yes
No
Any other accommodations?
Please sign me up for the DCC's newsletter and mailing list. You can unsubscribe anytime if it's not your thing.
End Date
disabilityculturalcenter.org