Magical Memories for Special Kids
edmonton

days
-6
-3
hours
0
-5
minutes
-2
-2
seconds
-3
-8

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 (as shown on passport): *
E-mail:
(Flight details for Dreams will be sent via email)
*
Address: *
Home Phone No: *
-
Cell Phone: *
-
Medical Number: Reg.#: *
Personal Health ID No.: *
Emergency Contact: *
Relationship to you: *
Home Phone No : *
-
Work Phone : *
-
Cell Phone : *
-
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?
ATTACH COPY OF VALID PASSPORT HERE

Upload all as a single document

Documentation:

I agree to take responsibility for the care of the children I am escorting and I am capable of attending to the children's needs during the entire trip. Dreams Take Flight Volunteers are not trained to address personal medical issues. I also agree to accompany the any of the children on rides in the park and to assist the group leader with the activities of the day. I acknowledge this is a non-smoking, no cell phone 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!!

I agree to these requirements *
Dated
Signature:
Enter the Code Shown:*
(*) Fields are Mandatory