Christmas Part Application 2020

  • Date Format: MM slash DD slash YYYY
  • (Note: Due to demand, please only register the immediate family of the patient to attend)
  • Child 1

  • Child 2

  • Child 3

  • Child 4

  • Please note that we will do our best to fill wish list requests but that we are limited to what we can provide.

    Audio/Visual release
    I understand that by authorizing this Audio/Visual Release form, I am irrevocably releasing the use of any likeness dialogue which has been recorded of my family for Shine Through the Rain, including its employees, agents or servants for any multi-media purpose that could include reproducing it on our website, or any other printed media associated with the organization, such as promotions, single images, or as wallpaper. All audio/visual records, recordings, negative and/or slides together with any prints shall constitute the property of Shine Through the Rain, solely and completely. Shine Through the Rain respects your privacy. We protect your personal information and adhere to all legislative requirements in protecting your privacy. We do not rent, sell, or trade our mailing lists. We see your personal information to provide services to keep you informed and up to date on our activities.