Join Mada Innovation Club Full Name * RequiredAge * RequiredOver 18Under 18 (Message: Kindly let your legal guardian fill/sign this form)Email * Required Phone Number * RequiredIn case of an emergency, contact:Emergency Contact Full Name * RequiredEmergency Contact Number * RequiredOccupationStudentEmployedNon – EmployedOther Other Qualifications * RequiredPost GraduateUniversityHigh schoolSecondary SchoolPrimary SchoolNoneLanguage Preference Arabic English Other Other Language preferenceHow do you access the computer? (More than one) * Required Doesn’t access to computer Keyboard and Mouse Specialized Software Eye Gaze Adapted Keyboard & Mouse Joysticks Touchscreen Speech Recognition Switch Other Other (How do you access the computer?)How do you prefer to communicate? (More than one or none) * Required Verbal communication Sign language AAC Systems Body gesture Other Other (How do you prefer to communicate?)Do you require additional environmental support?NoYesIf the answer is “Yes” kindly specifySensitive to lightSensitive to colorSensitive to soundCrowdednessOther Other Would you require a personal assistance?YesNoFull NameSignatureIf filled by a guardian describe the relation This iframe contains the logic required to handle Ajax powered Gravity Forms. Skip back to main navigation
