Family Application for Michael Fux Holiday Party

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Child Information

Nominated Child's First Name*:

Nominated Child's Last Name*:

Nominated Child's Age*:

Parent's Primary Language*:

Details of Special or Mobility Needs:

Parent/Guardian Information

Full name of Parent/Legal Guardian who will be attending the holiday party*:

Verify that you entered the name exactly as it appears on the government ID:

I confirmed the spelling*

Relationship to child*:

Guardian 1 Occupation:

Parent/Legal Guardian 2 who will be attending the holiday party*:

Relationship to child:

Guardian 2 Occupation:

Adult Limit Policy Acknowledgement*:

By checking this box, I acknowledge the hospital party's policy that due to capacity, only two (2) adults per household will be allowed to attend.

Contact information

Email address*:

Mobile/Cell Phone Number*:

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Text Message Authorization*:

I authorize Nicklaus Children's Hospital to send me text message reminders and updates regarding The 2025 Michael Fux Holiday Party. Message and data rates may apply. I understand I can opt out at any time by replying "STOP."
I do not authorize Nicklaus Children's Hospital to send me text message reminders about the Michael Fux Holiday party. I understand if I choose not to opt in to text messages that important updates and information will also be sent via email. I agree to check my email communication to stay informed about the party.

Address (line 1)*:

Address (line 2):

City and State*:

Postal / Zip Code*:

Household Information

Number of Siblings Under 18 years old in Household*:

Name and Age of Sibling 1:

Name and Age of Sibling 2:

Name and Age of Sibling 3:

Name and Age of Sibling 4:

Name and Age of Sibling 5:

Name and Age of Sibling 6: