Families with a child battling cancer, a blood disorder, or another life-threatening disease are invited to join us for a play date for a day of stories, crafts and play as we explore the wonderful world of Lilly the Lovable Ladybug!

Please fill out the form below to register for this event

How many will be attending?

This event is only for the immediate family: parent(s)/caregiver(s), warrior, and/or sibling(s)

Parent/Caregiver's Name

First Name

Last Name

Parent/Caregiver's Email

Parent/Caregiver's Cell Phone

(###)

###

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Second Parent/Caregiver's Name (If Attending)

First Name

Last Name

Warrior's Name

First Name

Last Name

Warrior's Hospital

Sibling's Names (If Attending)

How did you hear about this event?

Additional Comments

SMS Opt-In

By checking the box, I give permission to be contacted about Amanda Hope Rainbow Angels by SMS text at my residential or cellular number, dialed manually or by autodialer (consent to be contacted is not a condition to participate). I consent to be contacted even if my phone number appears on an Amanda Hope Rainbow Angels Do Not Call List, a State or National Do Not Call Registry, or any other Do Not Contact List.

Email Opt-In

By checking the box, I give permission to be contacted about Amanda Hope Rainbow Angels by email at my provided email address (consent to be contacted is not a condition to participate). I consent to be contacted even if my email address appears on an Amanda Hope Rainbow Angels Do Not Email List or any other Do Not Contact List.

Photo Consent

By checking this box, I give my permission for Amanda Hope Rainbow Angels 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 Amanda Hope Rainbow Angels 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 Amanda Hope Rainbow Angels programs, services or events. I gladly give this authorization to support the efforts of Amanda Hope Rainbow Angels. I understand this authorization shall continue until terminated in writing. Providing consent is not a requirement in order to participate in Amanda Hope Rainbow Angels programs.

COVID Waiver

By checking this box, I agree to comply with the written instructions below. I, wishing to receive services from Amanda Hope Rainbow Angels or participate in Amanda Hope Rainbow Angels 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 Amanda Hope Rainbow Angels’ policies and procedures for social distancing to reduce the spread of Novel Coronavirus, or COVID-19. I agree to wash or sanitize my hands after using the restroom, sneezing, coughing, and/or before handling food for distribution. Amanda Hope Rainbow Angels 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 Amanda Hope Rainbow Angels event. If at any point, I am no longer able to attend the event, I will immediately notify Amanda Hope Rainbow Angels’ Event Coordinator, Morgan Webre, via email (morgan@amandahope.org) or phone (602-612-5372). 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 Amanda Hope team beforehand, I agree to advise the Amanda Hope team at the next available opportunity.

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 Amanda Hope Rainbow Angels event consistent with core values of the organization.

Play Date at Lily's Pad

Please fill out the form below to register for this event

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Amanda Hope Rainbow Angels

amandahope.org

Play Date at Lily's Pad

Please fill out the form below to register for this event

Craft Day

Spa Day

Follow us!

Amanda Hope Rainbow Angels

amandahope.org