Team Will Hero Application

Fields marked with a * are required.

You can also fill out a Hero Application form and submit it by mail. Download pdf Form

Parent(s)/Guardian(s) contact information			Information will be kept confidential
*First Name		*Last Name		*Relation
Address
City		State	------------------ Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip
Phone		*Email
Child's Shirt Size	Youth Small | Youth Medium | Youth Large | Youth X-Large Adult Small | Adult Medium | Adult Large | Adult X-Large Adult XX-Large
What pediatric cancer organization/s would you like to see more support go towards?
Child's Bio			Information will be included on website
*First Name		*Last Name		Gender	Male Female
Birthdate
Sibling's Name(s) and Age(s)
*Cancer Diagnosis Date & Description
Current Health Status
Child's Support Website (i.e., www.caringbridge.org)
Hero's Image:
Child's Fun Facts			Information will be included on website
What is their favorite. . .
Color:			Food:
Book:			Movie:
Sport:			Animal:
Game:			Song:
If you could have a super power, what would it be?
What fun fact would you like to share about yourself with us?
What's your favorite activity(ies)/thing(s) to do?
RELEASE
I, as parent/guardian of above named child hereby apply to be a Team Will Hero. I consent to the use of my child's photograph and biographical information in connection with being listed on Team Will's website (http://www.team-will.org) as a Hero. I waive and release any and all claims, related to the broadcast and use of the photograph and biographical information, against Team Will and their officers, and agents. I understand, accept and support Team Will's use of our child's photo and story for its cause to raise public awareness and funds for cancer research and resources for children and their families impacted by cancer.
*I accept the terms of the Release
Leave this blank
Do not change this