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SHARE A VISION TRIP APPLICATION
Please provide all required information for an opportunity to be considered for an upcoming, all-expense paid trip, provided by Share A Vision. Note: If selected, you will be required to provide a $50 non-refundable deposit per attendee.
Child’s first and last name
Child’s birthdate
First and Last name of child's parents
First and Last name of child's siblings
Home Address
Phone number
Additional phone number
Email
School your child currently attends
Are you familiar with Share A Vision?
YES
NO
Has your child been on a Share A Vision trip before?
YES
NO
Have you been on a family vacation with your child before?
YES
NO
If yes, was the vacation in the past five years?
YES
NO
N/A
Has your child been on an airplane before?
YES
NO
Does your child have sensitivity to any of the following? (Check all that apply)
LOUD NOISE
BRIGHT LIGHT
HEAT
OTHER
NONE OF THE ABOVE
How does your child communicate (Check all that apply)
VERBAL
SEMI-VERBAL
COMMUNICATION DEVICE
OTHER
Can your child swim?
YES
NO
Does your child have any medical needs that we should be aware of? (Allergies, mobility issues, vision or hearing loss, etc.)
YES
NO
PREFER NOT TO DISCLOSE
If yes, please provide a short description.
If your child is selected, do you have additional family members you would like to bring on the trip at your own expense? (Maximum 2. If yes please list them below)
YES
NO
First and Last Name
Age
Relation
First and Last Name
Age
Relation
If your child is selected, are you willing and able to attend a minimum of 2 informational meetings?
YES
NO
If your child is selected, are you willing and able to bring your child to a minimum of 6 Disney World prep classes provided by Share A Vision?
YES
NO
Please tell us a little bit more about your child, and why you feel a Share A Vision trip would be beneficial for you.
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