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): *|
(Flight details for Dreams will be sent via email) *
|Home Phone No: *|
|Cell Phone: *|
|Medical Number: Reg.#: *|
|Personal Health ID No.: *|
|Emergency Contact: *|
|Relationship to you: *|
|Home Phone No : *|
|Work Phone : *|
|Cell Phone : *|
|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: *|
|Do you have any medical condition of which we and our medical doctors on the flight should be aware?|
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 *|
|Enter the Code Shown:*|
|(*) Fields are Mandatory|