If you have a child with special needs and would like to apply for our program, please fill out the annual enrollment form below.

Please also submit a copy of the doctor’s note or a current copy of the IEP, or other forms showing child’s eligibility. Once we receive your enrollment form, we will set up a phone interview with the family. You will receive a PayPal invoice for $60 for our enrollment fee. The fee with be waived if you sign up for our annual membership.

special event Enrollment Form

Note: This form includes a photo release. Please review our Terms & Conditions before your apply.

Name

First Name

Last Name

Email Address

Date

YYYY

How did you hear about All in Need?

Child's Information

Child's Full Name

First Name

Last Name

Child's Diagnosis

Age

Sex

Shirt Size

Birthdate

YYYY

Mailing Address

Phone

(###)

###

####

Allergies / Special Health Concerns

Child's Triggers (Set Offs)

Emergency Contact

Primary Emergency Contact

First Name

Last Name

Relationship to Child

Address

Phone

(###)

###

####

Secondary Emergency Contact

First Name

Last Name

Relationship to Child

Address

Phone

(###)

###

####

Photo Release

I hereby give permission to All in Need, Family Support to use photographic, video, or digital images in which I and/or my child(ren) may appear in publications used for the purpose of advertising and public relations. I understand that I will receive no payment for the use of images in which I and/or my child(ren) appear.

I Agree

I Disagree

Digital Signature

Please indicate that you have read and agree to the terms presented in the Terms and Conditions agreement.

I Agree

I release All in Need, Family Support and individuals from liability in case of accident during activities related to All in Need, Family Support as long as normal safety procedures have been taken.

First Name

Last Name

Date

YYYY

Additional Comments