Different Is Beautiful, Inc Participate Application

Different Is Beautiful, Inc Participate Application

860 Johnson Ferry Rd Suite 140-107 Atlanta, GA 30342
Passion Finders Program Participate Application

Thank you for your interest in applying for Different Is Beautiful, Inc. Passion Finders Program. Different Is Beautiful is a 501(c)(3) nonprofit that gives kids who were born "different" with an anomaly, birth defect, or special need that is physically noticeable an opportunity to pursue their passion and live a purposeful life by providing the resources for them to pursue and master that which they are most passionate about.

Different Is Beautiful, Inc. does not discriminate based on gender, race, creed, color, national or ethnic origin, disability, marital status, or sexual orientation in program admissions policies, employment practices, or any other programs. We celebrate diversity!
Does your child meet these qualifications? (if so, check the box)

The child is between the ages of 4 and 16 years old.The child was born "different" with an anomaly, birth defect, or special need that is physically noticeable.Without the help of Different Is Beautiful, Inc the family does not have the financial means available to afford the desired program.The child has the necessary support and transportation to maintain consistent attendance to their program without any interference.
Parent/ legal guardian Information
Parent/ legal guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Do you want to provide a second Phone Number?

Area CodePhone Number
Email
example@example.com
Child/ Participate Information
Name

First NameLast Name
Child's Age
Address (write same if it is the same as parent/ guardian)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Date of Birth

MonthDayYear
Date
Developmental Age
Child's T-shirt size
Child's "different" Information
What is :different" about your child?
We would love to know who referred you or how you found out about Different Is Beautiful, Inc?
What considerations or assistance, if any, does your child need to participate in his or her desired activity or passion?
Adaptive or Medical Equipment Needs or Requirements (list here)

What is your child's passion?

Please provide detailed information so we can find the right fit for your child in a program they will excel in!
What is your child's passion?
Explain in the next question. If it's not listed then, please let us know your child's passion.
Please explain the child's passion and what they want to do.
Do they have any experience or prior training? (if yes, please provide details)
What has the child done to display their passion? (ex: [gymnastics] doing cartwheels all day, [dancing] learning and practicing dance moves from videos, [football] tackling everyone they come in contact with, [drums] beating on pots/ pans.
Is your child willing to commit to a program and follow through to master their passion?
Do you have a particular program you prefer for your child? (dance academy, gymnast school, instructor, etc) If so, please list their business name, address, and phone number below. Since you know your area better than we do, we encourage you to find a place you trust and that can accomondate your child and let us know.
Family Household Information
Does the family have the finacial means available to afford the program you are seeking for your child without the help of Different Is Beautiful?

yesnopartially
What is the family's annual household income?
Is there anything else you'd like us to know? Just let us know. We are interested!

Agreement
**NOTICE: All information provided in this application is confidential and will only be used for Different Is Beautiful purposes.**
I give Different Is Beautiful, Inc. permission to share my child's conditional information with others for the sole purpose of pairing my child with the appropriate academy, school, instructor, individual, or business for the Passion Finders Program.

yesno
I understand that this application is not a guarantee that my child will be accepted by Different Is Beautiful's Passion Finders Program.

yesno
Signature

Clear
Name

First NameLast Name
Should be Empty:

Different Is Beautiful, Inc Participate Application

Parent/ legal guardian Information

Child/ Participate Information

Child's "different" Information

What is your child's passion?

Family Household Information

Agreement