Forever Family Application
Parent or legal guardian
Name
Relationship
Email
example@example.com
Phone number
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Spouse, co-parent or additional caregiver
Name
Relationship
Name of child who has, had, or succumbed to cancer
Birth date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Diagnosis and date
If applicable, date of remission
If applicable, date of demise
Sibling Information
Name
Birth date
Sibling Information
Name
Birth date
Sibling Information
Name
Birth date
Sibling Information
Name
Birth date
Sibling Information
Name
Birth date
Sibling Information
Name
Birth date
Please select the services in which you are interested:
Sibling Birthday Party
Sibling Academic Achievement Awards
Sibling Annual Essay Contest
Parents Advance Directives Seminar
Parents Reprieve Day Retreats
Parents Career and Financial Workshops
Annual Family Retreats
Family Meals During Convalescence
Family Enrichment Activities
What’s your story? Tell us about your phenomenal family.
Parental or Legal Guardian Consent: By signing this form, I grant my family permission to participate in activities, events, and resources (hereafter referred to as the “Activity”) provided by The Forever Jaiden Foundation, Inc. and to release, waive, discharge, and covenant not to sue, and agree to hold The Forever Jaiden Foundation, Inc. its trustees, officers, servants, agents, volunteers and employees (hereafter referred to as the “Releasees”) from and against any and all liabilities, demands, claims, or injuries, including death, that my family may sustain during or in conjunction with the Activity. Photographic Release: I hereby grant permission to The Forever Jaiden Foundation, Inc. and its Releasees to reproduce pictures taken of my family and to use our names with the photograph. I further consent that the use of my photo(s) may include, but is not limited to: The ForeverJaiden Foundation, Inc. website, newsletters, social media outlets, any publications, advertising and/or collateral materials. Confidentiality Policy: The Forever Jaiden Foundation, Inc. will not disclose any personal information about our families or our children (i.e. medical, demographic, contact information, etc.), to any persons or organizations without prior written consent, other than governing agencies as required by law.
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