Magical Memories for Special Kids
edmonton

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Individual Applications

Individual Application Information:

Name of Person Nominating Child: *
Home Number: *
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Cell Number: *
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E-mail: *

Note: You must provide contact information that remains valid between your application date and the flight date in September. If contact information changes, it is your responsibility to notify Dreams Take Flight immediately. Failure to do so may forfeit the child's seat on the aircraft!

Explain Your Reason for this Child Nomination: *

Important: Please provide a letter of recommendation for the nominated child, from the child's teacher, social worker, healthcare professional, social activity leader or member of your clergy, outlining the reasons why this child is an appropriate fit for Dreams Take Flight.

Please Upload:

Child Information:

Name of Nominated CHILD: *
Date of Birth (DD/MM/YR): *
As of Sept 20, 2017 - This CHILD will be how many years old? *
Does the child have any special needs? *
If "YES" please explain:
Additional Comments:

Parent or Guardian Information:

Parent or Guardian Name:
Parent Phone Number:
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Parent Cell Number: *
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Parent E-mail:
Address:
1. I have read and fully understand the requirements as noted in the "Children" tab on the DTF Edmonton Website: *
2. I fully understand all nominated children for Dreams Take Flight will require a valid CANADIAN long form birth certificate. *
3. If the nominated child is accepted the Parent / Guardian of the child will need to fill out a Child Fact Sheet and Consent Authorization Form. These documents will be provided sometime in March/April, by a DTF Director: *
4. Please explain the legal custodial status of the nominated child. Lives with: *
(*) Fields are Mandatory

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