Adult Participation Application

We gather information about every participant to better understand who comes to our program. Personal information will be kept confidential. As a non-profit organization that does not charge for our services, we rely solely on donations to underwrite our program and need the following information to help secure funding. Information provided to funders does not include identifying information. Your answers will, in no way, affect your ability to access all programs at Gilda’s Club Quad Cities at no charge. THANK YOU!