Magical Memories for Special Kids
edmonton

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Adult Escort 2014

These children are the authors of their own lives and destiny, and they will live with what they themselves create. But today, we are going to help open a new chapter in their life by giving each of them a special memory. It's memories like these, that no one can take away from them or us" It's a Dream Come True.......

Full Name: *
E-mail:
(Flight details for Dreams will be sent via email)
*
Name of child you are escorting: *
Mailing Address: *
Home Phone No: *
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Work Phone: *
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Cell Phone: *
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Medical Number: Reg.#: *
Personal Health ID No.: *
Emergency Contact: *
Relationship to you: *
Home Phone No : *
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Work Phone : *
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Cell Phone : *
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T-SHIRT SIZE
1 2 3 or Other
Special Dietary Requirements:
Please specify any dietary requirements you may have (i.e. Diabetic / allergies)

Medication: Please list ALL medication that you are currently taking. Indicate the dosage (amount and time) required during the trip.

Medication Name: *
Amount of dosage: *
Time: *
Do you have any medical condition of which we and our medical doctors on the flight should be aware?

Documentation:

I agree to take responsibility for the care of the child I am escorting and am capable of attending to the child's needs during the entire trip. Dreams Take Flight Volunteers are not trained to address personal medical issues. I also agree to accompany the child on rides in the Magic Kingdom and to assist the group leader with the activities of the day. I acknowledge this is a non-smoking day. Special permission has been granted to allow Dreams Take Flight to purchase souvenirs for the children; however, adults are not allowed to make purchases. Dreams Take Flight is dedicated to provide a wonderful fun-filled day for the children; it's their magical day!!

ATTACH COPY OF VALID PASSPORT HERE

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