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Play Without Limits Gaming Initiative
Applicant Name
*
Age
*
Parent(s) Annual Income
*
Parent(s) Name
*
Phone
*
Email
*
Address
*
Please tell us about yourself and your gaming experience.
*
Requested Gaming System
*
Choose one
Preferred Video Game ESRB Rating
*
Choose one
Types of Games Applicant Likes to Play
*
Action
Adventure
Casual
Fighter
Fantasy
Horror
Music
Multi-player
Puzzle
Platformer
Racing
Roleplaying
Sports
Shooter
Strategy
Please note any specific game requests.
Gaming Equipment Needed
*
TV
Second Controller
Wi-Fi Router
Headset / Headphones
Do you need Special Accommodations for Gaming? (Ex: Custom Controller, etc.) Please Specify:
Apply Now
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