• Souvenirs magiques pour des enfants speciaux

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Individual Applications

Individual Application Information:

Name of Person Nominating Child: *
Home Number: *
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Cell Number: *
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Email: *

Note: You must provide contact information that remains valid between now and the flight date of Sept 24, 2014. If contact information changes, it is your responsibility to notify Dreams Take Flight immediately. Failure to do so may forfeit the child's seat on the aircraft!

Explain Your Reason for this Child Nomination: *

Important:Please provide a letter of recommendation for the nominated child, from the childs teacher, social worker, healthcare professional, social activity leader or member of your clergy, outlining the reasons why this child is an appropriate fit for Dreams Take Flight.

Please Upload: *

Child Information:

Name of Nominated CHILD: *
Date of Birth (DD/MM/YR): *
As of Sept 24, 2014 - This CHILD will be how many years old? *
Does the child have any special needs? *
If "YES" please explain:
Additional Comments:

Parent or Guardian Information:

Parent or Guardian Name: *
Home Number : *
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Cell Number : *
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Email : *
Address : *
1. I have read and fully understand the requirements as noted in the "Child Selection" tab on the DTF Edmonton Website : *
2. I fully understand all the nominated children for the 2014 flight will require a valid Canadian Passport. Some Governmental assistance may be available : *
3. IF the nominated child is accepted the Parent / Guardian of the child will need to fill out a Child Fact Sheet and Consent Authorization Form. These documents will be provided sometime in February 2014, by a DTF Director: *
4. Please explain the legal custodial status of the nominated child. Lives with: *
Enter the Code Shown:*
(*) Fields are Mandatory