Runway for a Cure 2024 CHILD Model Sign Up Form

Parent/Guardian Name *

First

Last

Model/Child Name *

First

Last

Diagnosis *

Choose 1 *

Child Clothing Size DRESS (estimated size in March 2024) *

Child Clothing Size SHIRT (estimated size in March 2024) *

Child Clothing Size PANTS/SKIRT (estimated size in March 2024) *

Child Shoe Size (estimated size in March 2024) *

Email *

Child's Age on March 23rd 2024 *

Birthdate *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Child's Story for Program Book. (2-3 paragraphs) *

Photo/Photos for Program Book (max 5) *

Click or drag files to this area to upload. You can upload up to 5 files.

SMS and Email Opt. In *

By checking the box, I give permission to be contacted about Glimmer of Hope Foundation by SMS text at my residential or cellular number or provided email address, dialed manually or by autodialer (consent to be contacted is not a condition to participate) and to be contacted via email. I consent to be contacted even if my phone number or email address appears on a Glimmer of Hope Foundation Do Not Call / Do Not Email List, a State or National Do Not Call Registry, or any other Do Not Contact List.

Photo Consent *

By checking this box, I give my permission for Glimmer of Hope Foundation and/or its representatives to use artwork, photographs and/or letters that I provide of my child, my family, and/or myself in publications, slides, videotapes, motion pictures and/or on the Internet. In addition, I hereby give my permission for Glimmer of Hope Foundation and/or its representatives to photograph, audio tape record, and/or videotape my child or myself and to use our names, these images or voice recordings in publications, slides, videotapes, motion pictures and/or on the internet. I understand these visual images or voice recordings may be used to inform families, volunteers, donors, the media and general public about Glimmer of Hope Foundation programs, services or events. I gladly give this authorization to support the efforts of Glimmer of Hope Foundation. I understand this authorization shall continue until terminated in writing. Providing consent is not a requirement in order to participate in Glimmer of Hope Foundation programs.

COVID Waiver *

By checking this box, I agree to comply with the written instructions below. I, wishing to receive services from Glimmer of Hope Foundation or participate in Glimmer of Hope Foundation events/programming, hereby acknowledge that it is doing everything it can to protect the public as well myself and my family members in attendance. To this extent, I agree to follow Center of Disease Control (CDC) and local health district guidelines and Glimmer of Hope Foundation policies and procedures to reduce the spread of Novel Coronavirus, or COVID-19. I agree to wash or sanitize my hands after using the restroom, sneezing, and coughing, and before eating or preparing meals or sundries for distribution, and will properly wear and utilize sterile gloves and/or masks if requested by a Glimmer of Hope Foundation team member. Glimmer of Hope Foundation is not responsible for any potential exposure to Novel Coronavirus, or COVID-19, which is not a direct result of gross negligence on the part of its employees, volunteers, or the organization. Failure to comply with these written instructions or verbal instructions from staff may result in my family losing privileges to receive services and/or participate in events/programs and I may be asked to leave the premises.

Attendance Policy *

By checking this box, I agree to comply with the written policy below. By completing this form, I am registering for this Glimmer of Hope Foundation event. If at any point, I am no longer able to attend the event, I will immediately notify the Glimmer of Hope team via email (glimmerofhopefdn@gmail.com) or phone (401-580-8533). If I do not notify the organization before the event and do not show up at the event, I acknowledge that I will not be allowed to attend the next event. If the behavior continues, I acknowledge that I will be evaluated on an individual basis and may have all event attendance privileges revoked. If there is a medical emergency that causes me/my family to miss an event and I am unable to notify the Glimmer of Hope team beforehand, I agree to advise the Glimmer of Hope team at the next available opportunity. I also acknowledge that there will be (1) ticket per child for the child only. Friends and Family members of the child will be required to purchase a ticket to attend the show.

Rules of Conduct *

By checking this box, I agree to conduct myself in a polite and respectful manner towards all other attendees, staff, volunteers, and any other individuals when attending an Glimmer of Hope Foundation event consistent with core values of the organization.

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