Nathaniel's Hope ~ Sharing "the Hope" with Kids with Special Needs and their Families

Home » Events and Programs » Keep 'm Smiling » Registration » Orlando Guardians Football Game

Registration for Orlando Guardian's Football Game

You can register for this Keep ‘m Smiling event in one of the following ways:

1. Fill out the form below
2. Click here to open the form in PDF, print, complete, and fax it to us (407-447-2021)
3. Call us with the information (at 407-857-8224)

* indicates required fields

Adult Name *
Home Phone:
Cell Phone:
Work Phone:
Email Address:
Number of Adults Attending:
Number of Children Attending:
How did you hear about this Keep ‘m Smiling event?

If your child is already enrolled in our VIP Birthday Club and you receive mailings from us, please scroll down to the bottom and click on Submit. If your child is not a part of our Birthday Club or you are not receiving mailings, please fill in the following information:
Child's First Name:
Child's Last Name:
Child’s Birthday (mm/dd/yy):
Please explain your child’s uniqueness:
Child’s School:
Gender:	Male Female
What special equipment does your child use, if any (walker, wheelchair, etc.)?
What special talents or abilities does your child have?
Would you like for your child’s information to be included in the online VIP Birthday Club?	No Yes

Please indicate your preference regarding the online portion of the VIP Birthday Club:	Name on Web First name only on Web DON’T list name on Web Picture on Web DON’T put picture on Web
What is your relationship to the VIP?
Home Address:
City:
State:
Zip/Postal Code:
Home Church (if any):
Home Church City:
Do you speak…	Spanish? Sign Language?
Optional Demographic Information: When applying for grants, we are asked for certain information. By responding to these optional questions, you will be helping us in garnering funds for Nathaniel’s Hope.
Family income level: <$20,000 $20,001-30,000 $30,001-40,000 $40,001-50,000 $50,001-60,000 >$60,001
Race/Ethnicity: African-American/Black American Indian or Alaska Native Asian Indian Caucasian/White Chinese Filipino Guamanian or Chamorro Hispanic/Latino/Latina Japanese Korean Native Hawaiian Pacific Islander Samoan Vietnamese
Other, please specify

Release Form In consideration of me, my family, and/or my minor child(ren), I agree to indemnify and hold harmless Nathaniel’s Hope from all cost, expense, liability arising out of my family, my child’s, or my own participation in this event. I do hereby waive all claims for damage or loss to me, my family, or my child’s person or property which may be caused by any act, or failure to act, by Nathaniel’s Hope, its officers, agents, or employees from me, my family, or my child’s loss, damage, or other liability from such event. By my participation I grant Nathaniel’s Hope and any third party it may authorize, the right to photograph me and my family, and/or make recordings of my physical likeness and/or recordings of my voice for use in or in connection with exhibitions, video, magazines, newspapers, internet, or other publications or on television or radio. By submitting this form, I agree with the release form information above.

©2006 Nathaniels Hope | 2300 Jetport Drive, Orlando, FL 32809 | phone: 407-857-8224
Nathaniels Hope is an outreach of Teams Commissioned for Christ International,
a non-profit, 501(c)(3) Christian mission organization.

Nathaniel's Hope ~ Sharing "the Hope" with Kids with Special Needs and their Families

Registration for Orlando Guardian's Football Game

Release Form