Special Event Agreement Application

Thank you for your interest in hosting a special event to provide entertainment to patients at Nicklaus Children's Hospital All guests attending must read, complete, and sign this agreement.

If approved, I understand that my company or organization will be evaluated and must meet expectations in order to participate in any Nicklaus Children's events. Cancelations must be made no later than 48 HOURS PRIOR to the event. Nicklaus Children's Hospital staff reserves the right to cancel or discontinue special events at any time if they are thought to be inappropriate or unsafe for patients.

Organization or Company Name (if applicable):

Website*:

First Name of Contact*:

Last Name of Contact*:

Primary Email*:

Phone Number*:

( ) -

Address*:

City*:

State*:

Zip / Postal Code*:

Proposed Date of Event*:

Alternative Date of Event*:

Specify your Special Event Proposal in less than 500 Characters*:

Must engage the children in activity

Frequency of Event*:

One-time, annually, other frequency. If more, please specify. Please note a new event form must be submitted for each event.

Does Event Proposal include Characters?*:

Yes/No. If yes, please specify.
Please include quantity of characters/guests.

Will Costumed Characters/Special Event Guest need security?*:

Yes/No. If yes, please specify.
Please include quantity of characters/guests.

Will Characters need access to a break room? If so, for how long?*:

Yes/No. If yes, please specify.

Does Event Proposal include media request?*:

Press release, photography, videography needed? If yes, please specify.

Does your Event Proposal include Food & require a Hospital Catering Request?*:

Yes/No. If yes, please specify.

If Event Proposal includes a donation of Catering is proposed, please provide: company name, location, store number and a scanned copy of their insurance sent prior to event date. *:

We value your generosity. Please specify the Gift-in-Kind Value of this Event Proposal ($)*:

Organization/Company Guests*:

Five (5) Org./Company affiliated guests are permitted to support the event. The names included below agree to all Special Events Rules and Agreements. Additional guests may be advised pending written approval.

By checking this checkbox, I agree to abide by the Special Events Rules and Guidelines.
All guests agree to guidelines on the Guest Donors & Special Events Agreement provided.