Parent Information Parent/Guardian Name*
Legal First Name
Legal Last Name
Address*
Cell Phone*
Home Phone (if different from cell phone)
Email* Do you have a VIP?* Yes No
VIPs are kids with special needs. VIPs son ninos con necesidades especiales.
FAMILY INFORMATION How many family members, including yourself, are you registering?* 1 2 3 4 5 6 7 8 9 10
This must be immediate family members (dad, mom, and children).
Grandparents, aunts, uncles, cousins, etc. will need to complete a separate registration to participate.
How many family members from the above number are VIPs?* 1 2 3 4 5 6 7 8 9 10
Person #1 This should be the same name listed in Parent Information above.
Name*
Legal First Name
Legal Last Name
Person #2 Person Type* Community Participant VIP Family Member
Please click on the above drop down to choose.
Person Type* Select VIP
Please click on the above drop down to choose.
Name*
Legal First Name
Legal Last Name
Did this VIP receive a VIP Membership ID # ?* No Yes
If you registered and verified this child as a VIP with Nathaniel's Hope you should have received a VIP Membership ID #. If you did not receive it, you will need to upload proof of disability for this event.
Child #2 VIP Membership ID #*
Birthday* Gender* Male Female
Primary Diagnosis* Auditory Processing Disorder Autism Spectrum Bipolar Cerebral Palsy Chronic Condition Congenital Disorder Developmental Delay Down Syndrome Epilepsy/Seizure Disorder Hearing Impairment Intellectual/Cognitive Disability Learning Disability Life Threatening Illness Medical Disability Medically Fragile Mental Health Issue Mood/Behavior/Anxiety/Emotional Disorder Musculoskeletal Impariment Neurological Impairment Physical Disability Respiratory/Pulmonary Impairment Sensory Processing Disorder Speech/Language Impairment Visual Impairment Other Syndrome/Special Need ADD/ADHD
Acceptable Proof of Disability (You must upload one of the following):* IEP (only first page with VIP's name & diagnosis) Official letter from doctor on letterhead Official letter from licensed therapist on letterhead SSI Letter
These are the only documents that we now accept as proof of disability. The document that you upload must be current with the VIP's name, birth-date, and diagnosis explicitly stated.
(Photos of your VIP will not be accepted as proof of disability)
Please upload Proof of Disability (type chosen above)* *IF YOU ARE HAVING DIFFICULTY, THE FILE SIZE MAY BE TOO BIG.
What size shirt does your VIP wear?* Person #3 Person Type* Community Participant VIP VIP Family Member
Please click on the above drop down to choose.
Name*
Legal First Name
Legal Last Name
Did this VIP receive a VIP Membership ID # ?* No Yes
If you registered and verified this child as a VIP with Nathaniel's Hope you should have received a VIP Membership ID #. If you did not receive it, you will need to upload proof of disability for this event.
Child #3 VIP Membership ID #*
Birthday* Gender* Male Female
Primary Diagnosis* Auditory Processing Disorder Autism Spectrum Bipolar Cerebral Palsy Chronic Condition Congenital Disorder Developmental Delay Down Syndrome Epilepsy/Seizure Disorder Hearing Impairment Intellectual/Cognitive Disability Learning Disability Life Threatening Illness Medical Disability Medically Fragile Mental Health Issue Mood/Behavior/Anxiety/Emotional Disorder Musculoskeletal Impariment Neurological Impairment Physical Disability Respiratory/Pulmonary Impairment Sensory Processing Disorder Speech/Language Impairment Visual Impairment Other Syndrome/Special Need ADD/ADHD
Acceptable Proof of Disability (You must upload one of the following):* IEP (only first page with VIP's name & diagnosis) Official letter from doctor on letterhead Official letter from licensed therapist on letterhead SSI Letter
These are the only documents that we now accept as proof of disability. The document that you upload must be current with the VIP's name, birth-date, and diagnosis explicitly stated.
(Photos of your VIP will not be accepted as proof of disability)
Please upload Proof of Disability (type chosen above)* This is required even if you have previously submitted proof. *IF YOU ARE HAVING DIFFICULTY, THE FILE SIZE MAY BE TOO BIG.
What size shirt does your VIP wear?* Person #4 Person Type* Community Participant VIP VIP Family Member
Please click on the above drop down to choose.
Name*
Legal First Name
Legal Last Name
Did this VIP receive a VIP Membership ID # ?* No Yes
If you registered and verified this child as a VIP with Nathaniel's Hope you should have received a VIP Membership ID #. If you did not receive it, you will need to upload proof of disability for this event.
Child #4 VIP Membership ID #*
Birthday* Gender* Male Female
Primary Diagnosis* Auditory Processing Disorder Autism Spectrum Bipolar Cerebral Palsy Chronic Condition Congenital Disorder Developmental Delay Down Syndrome Epilepsy/Seizure Disorder Hearing Impairment Intellectual/Cognitive Disability Learning Disability Life Threatening Illness Medical Disability Medically Fragile Mental Health Issue Mood/Behavior/Anxiety/Emotional Disorder Musculoskeletal Impariment Neurological Impairment Physical Disability Respiratory/Pulmonary Impairment Sensory Processing Disorder Speech/Language Impairment Visual Impairment Other Syndrome/Special Need ADD/ADHD
Acceptable Proof of Disability (You must upload one of the following):* IEP (only first page with VIP's name & diagnosis) Official letter from doctor on letterhead Official letter from licensed therapist on letterhead SSI Letter
These are the only documents that we now accept as proof of disability. The document that you upload must be current with the VIP's name, birth-date, and diagnosis explicitly stated.
(Photos of your VIP will not be accepted as proof of disability)
Please upload Proof of Disability (type chosen above)* This is required even if you have previously submitted proof. *IF YOU ARE HAVING DIFFICULTY, THE FILE SIZE MAY BE TOO BIG.
What size shirt does your VIP wear?* Person #5 Person Type* Community Participant VIP VIP Family Member
Please click on the above drop down to choose.
Name*
Legal First Name
Legal Last Name
Did this VIP receive a VIP Membership ID # ?* No Yes
If you registered and verified this child as a VIP with Nathaniel's Hope you should have received a VIP Membership ID #. If you did not receive it, you will need to upload proof of disability for this event.
Child #5 VIP Membership ID #*
Birthday* Gender* Male Female
Primary Diagnosis* Auditory Processing Disorder Autism Spectrum Bipolar Cerebral Palsy Chronic Condition Congenital Disorder Developmental Delay Down Syndrome Epilepsy/Seizure Disorder Hearing Impairment Intellectual/Cognitive Disability Learning Disability Life Threatening Illness Medical Disability Medically Fragile Mental Health Issue Mood/Behavior/Anxiety/Emotional Disorder Musculoskeletal Impariment Neurological Impairment Physical Disability Respiratory/Pulmonary Impairment Sensory Processing Disorder Speech/Language Impairment Visual Impairment Other Syndrome/Special Need ADD/ADHD
Acceptable Proof of Disability (You must upload one of the following):* IEP (only first page with VIP's name & diagnosis) Official letter from doctor on letterhead Official letter from licensed therapist on letterhead SSI Letter
These are the only documents that we now accept as proof of disability. The document that you upload must be current with the VIP's name, birth-date, and diagnosis explicitly stated.
(Photos of your VIP will not be accepted as proof of disability)
Please upload Proof of Disability (type chosen above)* This is required even if you have previously submitted proof. *IF YOU ARE HAVING DIFFICULTY, THE FILE SIZE MAY BE TOO BIG.
What size shirt does your VIP wear?* Person #6 Person Type* Community Participant VIP VIP Family
Please click on the above drop down to choose.
Name*
Legal First Name
Legal Last Name
Did this VIP receive a VIP Membership ID # ?* No Yes
If you registered and verified this child as a VIP with Nathaniel's Hope you should have received a VIP Membership ID #. If you did not receive it, you will need to upload proof of disability for this event.
Child #6 VIP Membership ID #*
Birthday* Gender* Male Female
Primary Diagnosis* Auditory Processing Disorder Autism Spectrum Bipolar Cerebral Palsy Chronic Condition Congenital Disorder Developmental Delay Down Syndrome Epilepsy/Seizure Disorder Hearing Impairment Intellectual/Cognitive Disability Learning Disability Life Threatening Illness Medical Disability Medically Fragile Mental Health Issue Mood/Behavior/Anxiety/Emotional Disorder Musculoskeletal Impariment Neurological Impairment Physical Disability Respiratory/Pulmonary Impairment Sensory Processing Disorder Speech/Language Impairment Visual Impairment Other Syndrome/Special Need ADD/ADHD
Acceptable Proof of Disability (You must upload one of the following):* IEP (only first page with VIP's name & diagnosis) Official letter from doctor on letterhead Official letter from licensed therapist on letterhead SSI Letter
These are the only documents that we now accept as proof of disability. The document that you upload must be current with the VIP's name, birth-date, and diagnosis explicitly stated.
(Photos of your VIP will not be accepted as proof of disability)
Please upload Proof of Disability (type chosen above)* This is required even if you have previously submitted proof. *IF YOU ARE HAVING DIFFICULTY, THE FILE SIZE MAY BE TOO BIG.
What size shirt does your VIP wear?* Person #7 Person Type* Community Participant VIP VIP Family
Please click on the above drop down to choose.
Name*
Legal First Name
Legal Last Name
Did this VIP receive a VIP Membership ID # ?* No Yes
If you registered and verified this child as a VIP with Nathaniel's Hope you should have received a VIP Membership ID #. If you did not receive it, you will need to upload proof of disability for this event.
Child #7 VIP Membership ID #*
Birthday* Gender* Male Female
Primary Diagnosis* Auditory Processing Disorder Autism Spectrum Bipolar Cerebral Palsy Chronic Condition Congenital Disorder Developmental Delay Down Syndrome Epilepsy/Seizure Disorder Hearing Impairment Intellectual/Cognitive Disability Learning Disability Life Threatening Illness Medical Disability Medically Fragile Mental Health Issue Mood/Behavior/Anxiety/Emotional Disorder Musculoskeletal Impariment Neurological Impairment Physical Disability Respiratory/Pulmonary Impairment Sensory Processing Disorder Speech/Language Impairment Visual Impairment Other Syndrome/Special Need ADD/ADHD
Acceptable Proof of Disability (You must upload one of the following):* IEP (only first page with VIP's name & diagnosis) Official letter from doctor on letterhead Official letter from licensed therapist on letterhead SSI Letter
These are the only documents that we now accept as proof of disability. The document that you upload must be current with the VIP's name, birth-date, and diagnosis explicitly stated.
(Photos of your VIP will not be accepted as proof of disability)
Please upload Proof of Disability (type chosen above)* This is required even if you have previously submitted proof. *IF YOU ARE HAVING DIFFICULTY, THE FILE SIZE MAY BE TOO BIG.
What size shirt does your VIP wear?* Person #8 Person Type* Community Participant VIP VIP Family
Please click on the above drop down to choose.
Name*
Legal First Name
Legal Last Name
Did this VIP receive a VIP Membership ID # ?* No Yes
If you registered and verified this child as a VIP with Nathaniel's Hope you should have received a VIP Membership ID #. If you did not receive it, you will need to upload proof of disability for this event.
Child #8 VIP Membership ID #*
Birthday* Gender* Male Female
Primary Diagnosis* Auditory Processing Disorder Autism Spectrum Bipolar Cerebral Palsy Chronic Condition Congenital Disorder Developmental Delay Down Syndrome Epilepsy/Seizure Disorder Hearing Impairment Intellectual/Cognitive Disability Learning Disability Life Threatening Illness Medical Disability Medically Fragile Mental Health Issue Mood/Behavior/Anxiety/Emotional Disorder Musculoskeletal Impariment Neurological Impairment Physical Disability Respiratory/Pulmonary Impairment Sensory Processing Disorder Speech/Language Impairment Visual Impairment Other Syndrome/Special Need ADD/ADHD
Acceptable Proof of Disability (You must upload one of the following):* IEP (only first page with VIP's name & diagnosis) Official letter from doctor on letterhead Official letter from licensed therapist on letterhead SSI Letter
These are the only documents that we now accept as proof of disability. The document that you upload must be current with the VIP's name, birth-date, and diagnosis explicitly stated.
(Photos of your VIP will not be accepted as proof of disability)
Please upload Proof of Disability (type chosen above)* This is required even if you have previously submitted proof. *IF YOU ARE HAVING DIFFICULTY, THE FILE SIZE MAY BE TOO BIG.
What size shirt does your VIP wear?* Person #9 Person Type* Community Participant VIP VIP Family
Please click on the above drop down to choose.
Name*
Legal First Name
Legal Last Name
Did this VIP receive a VIP Membership ID # ?* No Yes
If you registered and verified this child as a VIP with Nathaniel's Hope you should have received a VIP Membership ID #. If you did not receive it, you will need to upload proof of disability for this event.
Child #9 VIP Membership ID #*
Birthday* Gender* Male Female
Primary Diagnosis* Auditory Processing Disorder Autism Spectrum Bipolar Cerebral Palsy Chronic Condition Congenital Disorder Developmental Delay Down Syndrome Epilepsy/Seizure Disorder Hearing Impairment Intellectual/Cognitive Disability Learning Disability Life Threatening Illness Medical Disability Medically Fragile Mental Health Issue Mood/Behavior/Anxiety/Emotional Disorder Musculoskeletal Impariment Neurological Impairment Physical Disability Respiratory/Pulmonary Impairment Sensory Processing Disorder Speech/Language Impairment Visual Impairment Other Syndrome/Special Need ADD/ADHD
Acceptable Proof of Disability (You must upload one of the following):* IEP (only first page with VIP's name & diagnosis) Official letter from doctor on letterhead Official letter from licensed therapist on letterhead SSI Letter
These are the only documents that we now accept as proof of disability. The document that you upload must be current with the VIP's name, birth-date, and diagnosis explicitly stated.
(Photos of your VIP will not be accepted as proof of disability)
Please upload Proof of Disability (type chosen above)* This is required even if you have previously submitted proof. *IF YOU ARE HAVING DIFFICULTY, THE FILE SIZE MAY BE TOO BIG.
What size shirt does your VIP wear?* Person #10 Person Type* Community Participant VIP VIP Family
Please click on the above drop down to choose.
Name*
Legal First Name
Legal Last Name
Did this VIP receive a VIP Membership ID # ?* No Yes
If you registered and verified this child as a VIP with Nathaniel's Hope you should have received a VIP Membership ID #. If you did not receive it, you will need to upload proof of disability for this event.
Child #10 VIP Membership ID #*
Birthday* Gender* Male Female
Primary Diagnosis* Auditory Processing Disorder Autism Spectrum Bipolar Cerebral Palsy Chronic Condition Congenital Disorder Developmental Delay Down Syndrome Epilepsy/Seizure Disorder Hearing Impairment Intellectual/Cognitive Disability Learning Disability Life Threatening Illness Medical Disability Medically Fragile Mental Health Issue Mood/Behavior/Anxiety/Emotional Disorder Musculoskeletal Impariment Neurological Impairment Physical Disability Respiratory/Pulmonary Impairment Sensory Processing Disorder Speech/Language Impairment Visual Impairment Other Syndrome/Special Need ADD/ADHD
Acceptable Proof of Disability (You must upload one of the following):* IEP (only first page with VIP's name & diagnosis) Official letter from doctor on letterhead Official letter from licensed therapist on letterhead SSI Letter
These are the only documents that we now accept as proof of disability. The document that you upload must be current with the VIP's name, birth-date, and diagnosis explicitly stated.
(Photos of your VIP will not be accepted as proof of disability)
Please upload Proof of Disability (type chosen above)* This is required even if you have previously submitted proof. *IF YOU ARE HAVING DIFFICULTY, THE FILE SIZE MAY BE TOO BIG.
What size shirt does your VIP wear?* Activity Release of Rights and Waiver of Liability This Activity Release of Rights and Waiver of Liability (“Release”) applies to all activities related to "Soaked 2023" sponsored by Vital Church on July 22, 2023, whether on the Vital Church campus or elsewhere, including during transportation to or from different locations.
By signing this Release, I declare that I understand and acknowledge the following:
Release* Waiver of Claims* Hold Harmless* Covenant not to Sue* Scope* Severability* Emergency Services* Photography & Video* Name*
By signing this registration, I affirm that I have read and agree to all information in this waiver.
Date*
MM slash DD slash YYYY
Family Entry*
Price:
Total
$0.00
Credit Card
Please hit submit only once to avoid multiple charges on your credit card.
Before submitting your registration, please confirm you are able to attend SOAKED 2024 as this a non-refundable $5 donation.
Name
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