Child's Gender *
Present School Name (if home schooled, enter "Home") *
Child's T-shirt Size *
Small Medium Large XL
Child's Diagnosis *
Does your child require wheelchair assistance? *
Does your child participate in the Special Olympics? *
I am the Child's: *
Does the child have transportation ? *
In miles-how far are you willing to travel to your child's adopting team? *
How did you hear about Team Up For 1?
Tell us about your child
What are your child's three favorite sports? *Please try to choose one for each season. (Ex. Soccor for Fall, Basketball for Winter, Lacrosse for Spring)
Favorite Characters from Books, Movies, or TV
Favorite activities as a family (going to the zoo, etc)
1. The undersigned has requested participation in Team Up For 1 programs. All participants agree to forever release and absolve Team Up For 1 Foundation for, from and against any and all liability, damages and claims of any kind, known and unknown which may be connected with a result from participation in Team Up For 1 participation programs. 2. Participants
understand and agree that involvement in Team Up For 1 Foundation Programs may involve injury or harm to the Participants and agree that this risk is fully assumed by the Participants. This includes, but not limited to problems connected with transportation, lodging, food, all medical conditions, publicity to include photographs, accidental injury, death or harm to the Participants and that all risk is fully assumed by all Participants. Participants agree to carry full medical coverage or assume personal responsibility for failing to carry adequate medical insurance. The Participants hold Team Up For 1 Foundation harmless for any loss as the result of any claim, lawsuit or action arising out of or relating to the preparation, execution or fulfillment of the benefit conferred upon the Participants. 3. The undersigned both individually and on behalf of the child who is eligible to participate in Team Up For 1 Foundation Programs does release and absolve Team Up For 1 Foundation, their volunteers, employees, directors and agents and all other persons, businesses and corporations which may be liable from any and all actions, causes of action, claims and demands for, any damage for any incidents or occurrence which occur during the participation or consideration of participation in Team Up For 1 Foundation Programs. 4. The parent(s) or legal guardian(s) gives permission to Team Up For 1 Foundation to contact the physician and/or medical personnel familiar with the child's medical diagnosis. This will determine the child's eligibility in Team Up For 1 Foundation Programs. All physicians and/or medical personnel have permission to release my child's medical information to the Team Up For 1 Foundation. The parents or legal guardians have made true and full disclosure of the medical condition and all additional information to Team Up For 1Foundation. The parents or legal guardians understand that the Team Up For 1 Foundation may disclose their child's information to any third party involved in program participation. 5. It is further understood that this permit contains the entire agreement between the Participants and Team Up For 1 Foundation. All participants involved agree to the terms in this permit. This agreement expresses the understanding of all participants in Team Up For 1 Programs. By signing, you agree and acknowledge that you have fully read and understand this agreement.
The undersigned agrees to the following: 1. It is understood and agreed that participation in Team Up For 1 Foundation Programs may result in publicity. By signing this permit you are allowing Team Up For 1Foundation to use the name, photos or video of all Participants, for publicity purposes. 2. Team Up For 1 Foundation is very aware of the desire for privacy and will respect any reasonable requests from program Participants. However, the media or general public may acquire information concerning the Participants and any event; thus publicity may result. Each Participant must understand that information regarding Team Up For 1 Programs may be publicized and the Participants release Team Up For 1 Foundation from all liability. Each of the Participants hereby releases Team Up For 1 Foundation from all damages, liability or claims resulting from, or arising from the use, distribution or disclosure of any photographs, films, newsletters, videotapes, websites, press releases or other information regarding Participants. 3. I agree that all Participants have read and understand this Publicity Permit for Team Up For 1 Foundation programs prior to signing it. The undersigned authorize and hereby bind themselves, their minor children, and all participants, their heirs, successors and estates to the conditions in this release. Each Participant agrees that this permit is accurate and expresses the understanding of each and every Participant. Each of the Participants agrees that no modification of this release has been made orally or in writing and this release accurately and fully expresses the understanding of all Participants 4. By submitting this form, you agree and acknowledge that you have read and fully understand this agreement. All Participants involved agree to all terms in this permit. The agreement expresses the understanding of all Participants in Team Up For 1 Foundation Programs. 5. It is further understood that this release contains the entire agreement between the Participants and Team Up For 1 Foundation concerning publicity. All Participants involved agree to the terms in this release. This agreement expresses the understanding of all participants in Team Up For 1 Programs. By signing, you agree and acknowledge that you have fully read and understand this agreement. By signing this permit, you are allowing Team Up For 1 Foundation to use the name, photos or video of all Participants for publicity purposes.
Terms of service *
I have read and agree to both the liability as well as the publicity permits
Please select your relationship to the child *
Electronic Signature *
On behalf of Team Up For 1, thank you for your submission. This is the first step towards a life changing experience for your child as well as your family! We will be in touch as soon as possible and look forward to meeting you! Please click the "SUBMIT FORM" button to send us your form.