Thanks for your interest in the Flight1 program. 
Flight1 is free for all children in the program. 
So, welcome aboard and we hope that we can serve your family well.
To continue we have just a few questions for you.
start
 
What's your first name? *

 
What's your last name? *

 
And your phone number?

 
Which scenario applies to your family? *

Our mission is to serve children affected by serious health challenges.  One of the following needs to be true to participate in the program.

 
The next groups of question will ask for information for each child(ren) in your household.

 
How many children are in your household?


 
Child 4 Information

 
What is your child's first name?

 
If {{answer_14119533}}'s last name is different from {{answer_14108786}} please enter it here.

 
What is {{answer_14119533}}'s gender?


 
When is {{answer_14119533}}'s Birthday?

 
Child 3 Information

 
What is your child's first name?

 
If {{answer_14120958}}'s last name is different from {{answer_14108786}} please enter it here.

 
What is {{answer_14120958}}'s gender?


 
When is {{answer_14120958}}'s Birthday?

 
Child 2 Information

 
What is your child's first name?

 
If {{answer_14129881}}'s last name is different from {{answer_14108786}} please enter it here.

 
What is {{answer_14129881}}'s gender?


 
What is {{answer_14129881}}'s birthday?

 
Child 1 Information

 
What is your child's first name?

 
If {{answer_14118783}}'s last name is different from {{answer_14108786}} please enter it here.

 
What is {{answer_14118783}}'s gender?


 
When is {{answer_14118783}}'s Birthday?

 
Great!
We are almost done.
Only a couple more legal boxes to check and we will be done.

 
Media Release and License for the {{answer_14108786}} household

“We’d like to share your story”  

To keep supporters, participants and others engaged with the ongoing activities of Flight1, we like to share stories of the work we are doing.  But we need your permission to do so.  

I,{{answer_14108599}} {{answer_14108786}} am the parent or legal guardian of the above listed chid(ren).  For myself and on behalf of my child(ren), I hereby give Flight1, Inc. permission to take photographs and videos of me and of my child(ren) and to record my voice and my child(ren)'s voice, and I hereby grant Flight1, Inc. an irrevocable, worldwide license and right to use any such photographs, videos and/or recordings, singularly or in conjunction with other photographs, videos and/or recordings, as well as the name, likeness, voice and story of me and of my child(ren)(collectively the “Materials”) for publicity, marketing, promotional, educational or other similar purposes.  The Materials may be exhibited and exploited in printed materials, on the Internet, on television or video, or otherwise by any means in any media, now known or hereafter devised, in perpetuity.

     
 
Waiver and Release of Claims and Liability, Assumption of Risk and Indemnity Agreement

As used below, the term "Released Parties" means Flight1, Inc., its directors, officers, employees, agents, volunteers, independent contractors, representatives, successors and assigns, and the term "Activities" means all activities, events and services provided, arranged, organized, conducted, sponsored or authorized by the Released Parties, including, but not limited to, airplane flights, airport tours and flight shows.  

For myself,{{answer_14108599}}{{answer_14108786}}, and for my child(ren), (listed above), and in consideration of being permitted to participate in the Activities and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I hereby:  

1.WAIVE AND RELEASE ANY AND ALL CLAIMS that I have, or may in the future have, against the Released Parties, and I RELEASE the Released Parties from any and all liability for any loss, damage, cost, expense, or injury, including death, that I or my child(ren) may suffer, or that my next of kin may suffer, arising out of or connected to participation by me or my child(ren) in the Activities DUE TO ANY CAUSE WHATSOEVER, including NEGLIGENCE, BREACH OF CONTRACT, BREACH OF ANY STATUTORY DUTY OR OTHER DUTY OF CARE on the part of the Released Parties or others, including, but not limited to, a failure on the part of the Released Parties to  safeguard or protect me or my child(ren) from the risks, dangers and hazards of the Activities;
2.ACKNOWLEDGE that there are risks, dangers and hazards associated with the Activities, and I ASSUME ALL OF THE RISKS, DANGERS and HAZARDS associated with the Activities and any INJURIES AND LOSSES that I or my child(ren) may sustain, no matter how severe, that are in any way connected with the Activities;
3.RELEASE, INDEMNIFY AND HOLD HARMLESS the Released Parties from any and all claims, demands, causes of action, costs and expenses, including, but not limited to, reasonable attorneys' fees, that are in any way connected with the Activities, including, but not limited to, claims arising out of allegedly negligent acts or omissions of the Released Parties, any claims for damages for injury or death sustained by me, my child(ren) or any other person or entity, and for any and all claims of any kind or nature arising out of participating in the Activities.  

I UNDERSTAND THAT BY ACCEPTANCE OF THESE TERMS, I AM SURRENDERING VALUABLE RIGHTS, INCLUDING, BUT NOT LIMITED TO, THE RIGHT TO SUE, FOR MYSELF, FOR MY CHILD(REN) AND FOR OTHERS ON MY BEHALF AND ON BEHALF OF MY CHILD(REN), AND I DO SO FREELY.
     
Thank you. 
We have received your form.  Someone from Flight1 will contact you shortly with more details on the program.
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