Below you will find an online form to fill out and submit to us.  Thank you.

Liberty Client Sign Up

  • Please enter your child's full name.
    Please check the box that represents the member's ethnicity.
    I hereby authorize Inclusion Connections to give consent for any and all necessary emergency medical and first aid care for my child. I do hereby release and hold harmless Inclusion Connections Inc., its employees and representatives from liability, claims or causes of action for any illness/injury to person or damage to property resulting from, or occurring during Inclusion Connections, Inc. sponsored activities. I also understand that photos from the activities may be used in printed materials for marketing purposes, on the Inclusion Connections, Inc. website or Facebook page and in future print materials. I give my permission to release any photos taken.