• 2026 Participation Form

    To qualify for our Quality of Life programs, participants must be between the ages of 6-21 and have been seen at Carrie Tingley Hospital in the last three years (clinic visit, check-up, routine shots/immunizations, etc.). Participants between the ages of 18-21 are considered Ambassadors and may be asked to lead activities, attend photoshoots, etc. to support programs and gain life skills.

  • Participant Information

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Participant T-shirt Size*

  • Guardian Information

  • Format: (000) 000-0000.

  • Updates to Information

    If at any point your information changes (phone number, health needs, etc.), please reach out to provide updates that we can manage on the back end. You do not need to fill out this form every time something changes.

  • Emergency Contact Info

    In the event of an emergency where the guardian is not present or is unable to make decisions or manage the participants' health and safety, the individual listed below will be contacted, informed of the situation, and asked to pick up the participant from the program.
  • Format: (000) 000-0000.
  • Is this person authorized to pick up/transport the participant if needed?*

  • Program Registration

    By completing this form, you'll be added to our program contact list to receive monthly emails with program signups and important updates. The program sign-ups sent monthly will allow for custom selection of which programs your family plans to attend. Once you submit that form, you'll receive custom updates (cancellations, weather updates, etc.) as needed based on the programs selected. Please note: families who don't submit a monthly selection will not receive program-specific updates for that month.
  • How would you like to receive information about monthly programs/events? By selecting the option(s) below, you consent to receiving communications from us in the chosen format(s). Please note that our text software does not always work - email is the most consistent form of communication for now.*
  • The list below notes the planned programs/activities for 2026. Please select the programs your child is most interested in - this helps us better anticipate demand for certain programs. Please note that not all of these are programs hosted solely by CTHF - additional forms/waivers/etc. may be required for some of these due to partnership with external organizations.*

  • Large-Scale Program Note

    Please note that for large-scale programs like Day of the Tread, Camp Adventure, and similar, communication and confirmation of attendance will be sent much further in advance to account for large-scale purchases and logistics related to those programs (t-shirt orders, venue reservations, etc.).

  • Health History

    The information provided in this section may be shared with specific parties as needed to support the participant’s safety and accommodations. For example, volunteers working one-on-one with the participant may need to understand limitations, and emergency responders may require medical history to provide appropriate care if a guardian is not present.
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  • Behavior & Dietary Support

    The information provided in this section will be shared with certain parties as needed to support the participant’s experience at programs.

  • Consent Forms

  • Behavior Agreement

    I understand that Carrie Tingley Hospital Foundation and its program partners are dedicated to providing a safe, fun, and inclusive environment for all participants. To ensure a positive experience, I understand that my participant and any guardians staying to support my participant must follow the behavior expectations outlined below:

    Kindness & Inclusion - participants should be kind, inclusive, and use respectful language. Bullying, teasing, or exclusion will not be tolerated.

    Following Directions - participants must follow directions provided by staff and volunteers. Participants that refuse to follow directions may be asked to step out of the activity for their own safety/the safety of others.

    Respect for Property - participants should be respectful of the facilities in use, as well as all equipment provided for the program. Misuse of equipment and facilities will not be tolerated and may result in being asked to leave the program.

    Safe Spaces - pets, weapons, cigarettes, vapes, alcohol, drugs and other paraphernalia are not permitted at our programs. Participants found to have brought any of these types of items may be asked to leave the program.

  • Medical Release and Authorization

    Authorization for Basic Care
    As the parent and/or legal guardian of the named participant, I authorize the staff, volunteers, and program partners of the Carrie Tingley Hospital Foundation ("the Foundation") to provide basic medical care, such as first aid or CPR, if the need arises during programs the participant attends. I understand that staff and volunteers will only administer care for which they have received proper training and certification from a recognized accrediting body.

    Communicable Disease Acknowledgment
    I understand that participation in group activities carries an inherent risk of exposure to communicable illness, and I assume that risk on behalf of the participant, in addition to the risks described above.

    Transport Limitations
    If the participant requires medical treatment beyond basic care, they may only be transported by a legal guardian, an emergency contact, or professional emergency services (e.g., ambulance, life-flight). Staff, volunteers, and partners of the Foundation will not transport the participant to an urgent care center, emergency room, or any other medical facility.

    Notification and Escalation
    In the event emergency medical care is necessary, every reasonable effort will be made to contact the parent/guardian listed on this form. If no response is received, the emergency contact will be notified. If neither the guardian nor the emergency contact can be reached, the Foundation may contact professional emergency services to transport the participant for medical evaluation and treatment.

    Use and Disclosure of Medical Information

    I authorize the Foundation to share the medical information provided on this form including allergies, medications, and medical conditions with staff, volunteers, program partners, and/or emergency medical personnel who work directly with the participant, solely for the purpose of providing appropriate care, accommodations, and emergency response and only if needed. If it's not relevant, information will not be shared with any parties. This authorization remains in effect for the duration of the participant's enrollment in Foundation programs and may be revoked in writing at any time by contacting the Foundation; revocation will not affect care already provided in reliance on this authorization.

    Financial Responsibility
    All medical expenses incurred as a result of illness or injury during participation in these programs are the sole financial responsibility of the participant's parent/guardian and/or their health insurance provider.

    Release for Care Provided in Good Faith
    I release and hold harmless the Foundation, its staff, volunteers, and affiliates from any claims, liabilities, or expenses arising from medical care provided in good faith under this authorization.

    Validity Period
    This Medical Release is valid for the program year in which it is signed and must be renewed annually or upon any material change to the participant's medical information, whichever comes first.

  • Consent Statements

    Consent to Participate
    I, the undersigned parent and/or legal guardian, consent to the named participant's involvement in all activities organized by the Foundation and/or its program partners during programs for which the participant is registered.

    Assumption of Risk
    I understand that participation in Foundation programs, including adaptive sports and physical activities, carries inherent risks, and I voluntarily assume all such risks and hazards, including those occurring during travel to and from program sessions. I understand these risks include, but are not limited to, sprains, fractures, dislocations, cardiac events, paralysis, and other serious injury, including death. I confirm that I am not relying on any oral or written representation of safety made by the Foundation, its staff, volunteers, or program partners, other than what is written in this document.

    Release, Waiver, and Indemnification
    To the fullest extent permitted by law, I release, waive, discharge, and covenant not to sue, and further agree to indemnify and hold harmless, the Foundation, its officers, directors, agents, employees, volunteers, program partners, sponsors, advertisers, and any affiliated entities, and, where applicable, owners or lessors of program venues (collectively, the "Released Parties") from any and all liability, claims, demands, actions, or causes of action whatsoever, whether arising from negligence or otherwise, on account of injury, disability, death, or property damage arising out of or related to the participant's participation in program activities.

    This release and indemnification is made on behalf of myself on behalf of the participant named on this form, and our respective heirs, executors, administrators, successors, and assigns.

  • Media Waiver

    Grant of Rights
    In consideration of the participant's involvement in Foundation programs, or programs hosted by Foundation partners, I grant permission to the Foundation and its staff and affiliates to record, photograph, and use the participant's name, appearance, performance, and/or voice in published media — including print, broadcast, the Foundation's website, and its social media channels — for the purpose of promotion, reporting, fundraising, or publication related to the organization's mission. I understand the Foundation may edit, crop, caption, or combine this material with other content for its promotional and reporting purposes.

    No royalty, fee, or other compensation of any kind shall become payable to me for the Foundation's use of the participant's name, appearance, likeness, or voice under this waiver

    There is no time limit on the validity of this release, nor any geographic limitation on where these materials may be distributed. This grant is limited to use by the Foundation and its affiliates for their own promotional, reporting, and fundraising purposes; it does not authorize sale or licensing of the participant's name, image, or voice to unaffiliated third parties for commercial purposes.


    This release is irrevocable as to any materials already published, produced, or distributed prior to receipt of a written revocation request. Guardians may revoke permission for future use of the participant's name, image, or voice in materials not yet published by submitting written notice to the Foundation.

  • Confirmation

    By signing and dating below, I confirm that the information provided on this form is true and accurate to the best of my knowledge. By signing and dating below, I agree to abide by the waivers and releases listed above. I acknowledge that by submitting my electronic signature, it carries the same legal effect as a handwritten signature and is equally binding.
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
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