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 *
Name
Date *
Date
Child's Information
Child's Full Name *
Child's Full Name
Birthdate *
Birthdate
Phone *
Phone
Emergency Contact
Primary Emergency Contact *
Primary Emergency Contact
Phone *
Phone
Secondary Emergency Contact *
Secondary Emergency Contact
Phone *
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. *
Digital Signature
Please indicate that you have read and agree to the terms presented in the Terms and Conditions agreement. *
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. *
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.
Date *
Date