Guardian's Name *

First Name

Last Name

Guardian's Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian's Contact Phone Number *

(###)

###

####

Preferred Contact Method

Phone

Email

Warrior's Name *

First Name

Last Name

Warrior's Gender

Girl

Boy

Warrior under isolation protocols *

Yes

No

Photo Release Form *

I hereby authorize Nathaniel’s Childhood Cancer Foundation Inc., to publish the photographs, or videos taken of me and/or my children, along with our names if desired, for use in printed publications, videos and on authorized web sites. I acknowledge that, since my participation in media produced by these entities is voluntary, I will receive no financial compensation. I further agree that my participation in any media produced by these entities confers upon me no rights of ownership whatsoever. I release these entities and their officers, directors, managers, members, partners, agents, volunteers, employees and board members from liability for any claims by me or any third party in connection with my participation.

Authorize

Do not Authorize

Inclusion of Christian Based Material

Nathaniel’s Childhood Cancer Foundation is a Christian based organization. Each Warrior and/or Protector pack will include Christian based material which includes an age-appropriate Bible. Due to Nathaniel’s Childhood Cancer Foundation’s strong Christian values, the inclusion of the Christian based material is not an option that can be opted out of. By submitting this request form, you, hereby authorize Nathaniel’s Childhood Cancer Foundation Inc. to include Christian based material in your child’s/children’s warrior and/or protector packs.”

Authorize