Member Registration & Waiver
💖Annual registration for families and program & event access. We can't wait to see you at our events! 🙂
Note:
🚨This form is for families and/or individuals ONLY. If you are a school, PT/OT, organization or group of any kind - this form is NOT for you. Sign up for our newsletter on our website for updates or fill out our medical equipment request form on our website at wecant2wecan.org/programs!
Guidelines:
🚨 Eligibility Notice: We are a New Jersey–based nonprofit dedicated to serving children with disabilities through inclusive events, children’s books that highlight real kids with disabilities, and free pediatric medical equipment for families in need. Our programs are intended for children ages 2–21 who have disabilities, or are medically fragile (age range not limited). Eligibility requirements apply to all participants. Our events are specifically designed to support children within the disability and medically fragile community. We kindly ask families to honor the intention behind these programs and register only if your child meets the eligibility criteria.
Your Full Name
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First Name
Last Name
Email Address (this is our ONLY form of contact)
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your relation to the child/adult with disability you are applying for?
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Parent
Grandparent
Caregiver
Legal Guardian
Other
Would you, as a parent or caregiver, benefit from a parent support group?This may include peer support, resource sharing, or facilitated conversations with other caregivers.
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Yes
No
Maybe/I'd like more information
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"We Can Kid" Information Section🦸🦸‍♀️
This form is for children with qualifying disabilities only, including but not limited to cerebral palsy, autism, Down syndrome, spinal muscular atrophy (SMA), rare genetic disorders, rare diseases, or other disabilities. Please fill out one form per qualifying child. * Siblings without disabilities are welcome at events and do not require registration.*
Child / Adult's Name
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First Name
Last Name
Please Select Sex
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Male
Female
Birth Date
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Please select a month
January
February
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Month
Please select a day
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Day
Please select a year
2026
2025
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Year
Do you give us permission to send you a birthday email and/or physical card?
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Yes
No
Tell us about your "We Can Kid!"
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List their disability/disabilities:
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Was this disability diagnosed by a doctor?
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No formal diagnosis at this time
Not yet diagnosed, pending disability diagnose
Yes
Do you have documentation related to this diagnosis (if applicable)
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No
Yes, I have documentation available if needed
Other
Does your child require medical equipment, adaptive devices, or mobility support?
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No
Yes
Does your child receive or qualify for special education services, early intervention, or therapeutic support?
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Yes
No
Does your child have limitations that impact daily activities (mobility, communication, sensory processing, medical care, etc.)?
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No
Yes
Please tell us if they use mobility aids such as wheelchair, walking cane, walkers, hearing aids, communication device, etc. Put n/a if not applicable.
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Are there any medical milestones, surgical anniversaries, important medical updates, or upcoming procedures your child is celebrating or preparing for? This information helps us better support families through encouragement, recognition, or thoughtful outreach.
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Yes
No
If selected yes, please describe (Examples: surgery anniversary, treatment milestone, upcoming surgery, recovery goal, etc.):
Is your child currently feeling nervous or anxious about an upcoming surgery or medical procedure?
Yes
No
If selected yes, please share any anticipated dates:
 -
Month
 -
Day
Year
Date
If selected yes, please share any anticipated dates:
 -
Month
 -
Day
Year
Date
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Program Opportunities
Are you aware of our free medical equipment program - Resource Recycler?
Yes
No
Our Latest Event!
We host seasonal Free Inclusive Photoshoots designed to celebrate children with disabilities while helping raise representation within the disability community. Families selected for these opportunities will be contacted separately.
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Yes, I would like to be considered.
No, I would not like to be considered.
Would you like to be considered for a superhero role in our children's book series?
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Yes, I would like to be considered.
No, I would not like to be considered.
I would like more information.
If you selected yes for any of the questions above, please upload a picture of your participant. (headshot if applicable)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Rate your experience with our nonprofit organization, if applicable.
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2
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Please leave any feedback, comments or experiences.
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AGREEMENTS & ACKNOWLEDGMENTS
Program Eligibility & Truthful Disclosure
By submitting this form, I attest that the child/adult listed has a disability, or medical condition, that qualifies them for participation in programs offered by From We Can’t to We Can. I understand that these programs and resources are exclusively for children with disabilities or medical fragility, and that providing false or misleading information may result in removal from programs and loss of access to future services and resources.
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I confirm that the information provided is true and accurate.
Assumption of Risk & Release of Liability: I acknowledge that participation in events, programs, activities, or services hosted by From We Can’t to We Can may involve certain inherent risks. I voluntarily assume all such risks on behalf of myself and my child(ren). I hereby release, waive, and hold harmless From We Can’t to We Can, its officers, directors, employees, volunteers, sponsors, partners, and affiliates from any and all claims, demands, actions, or causes of action arising out of or related to participation in any program or event.
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I agree to the above release of liability and understand that I am waiving certain legal rights.
Media Release & Photo/Video Permission: I grant permission for From We Can’t to We Can to photograph, record, and use images or videos of my child(ren) and family taken during events or programs for nonprofit purposes, including but not limited to social media, marketing materials, publications, and promotional content.
*
Yes, I grant permission
Member ID Acknowledgment: I understand that upon review and approval of this waiver and application, my family will be issued a We Can’t to We Can Member ID. This Member ID may be used for event check-ins, program participation, and internal tracking purposes. I acknowledge that the Member ID will be sent electronically and is required for participation in certain programs or events.
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I understand and agree.
Mailing & Welcome Card Permission: From We Can’t to We Can loves welcoming new families! 🙂 Please let us know if we may send a welcome card to the mailing address provided on this form.
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Yes, you may send mail.
No, please do not send mail.
Due to limited capacity and high demand for our programs and events, we ask families to be mindful when registering: I understand that if my family registers for an event and does not attend without prior notice (no-show/no-call) for more than one event, we will be temporarily ineligible to register for the following event. This policy helps ensure that opportunities and resources are available to families who are able to attend.
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I understand and agree to the attendance policy.
By signing below, I acknowledge and agree to the terms of the 2026 Annual Member Waiver.
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Submit Waiver
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