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Kathy Ireland joins NPCF as “International Youth Chair”
Events
Fashion Shows
Atlanta, GA | 8/18/2023
Charlotte, NC | 9/16/2023
Sarasota, FL | 9/29/2023
St. Petersburg, FL | 10/6/2023
Houston, TX | 10/21/2023
Fishing Tournaments
St. Pete, FL | 10/5-10/7/2023
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Apply to Become a Model in a NPCF Fashion Show
Featured Model Form
"
*
" indicates required fields
Which Fashion Show Would You Like To Participate In?
*
Select all that apply.
Atlanta, GA (August 18, 2023)
Charlotte, NC (September 16, 2023)
Sarasota, FL (September 29, 2023)
St. Petersburg, FL (October 6, 2023)
Houston, TX (October 21, 2023)
Child's Name
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First
Last
Parent's Name
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First
Last
Address
*
Street Address
Apt or Suite
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Cell Phone Number
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Email
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Child's Date of Birth
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MM slash DD slash YYYY
Have you ever walked in a NPCF Fashion Show before?
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Yes
No
Name of School
Grade
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Hobbies/Interests
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Tell us about your most memorable experience.
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Please share your cancer journey?
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How Would You Describe Your Child's Personality?
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Share a cute, meaningful, or funny moment about your child?
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What does your child want to be when they grow up? (option 1)
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What does your child want to be when they grow up? (option 2)
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What does your child want to be when they grow up? (option 3)
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Other Information
Girls Top/Dress Size
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N/A
2
2T
3
3T
4/4T
5 (XXS)
6 (XS)
6x
7 (S)
8
10 (M)
12 (M)
14 (L)
16 (L)
18 (XL)
20 (XL)
Girls Bottom Size
*
N/A
2
2T
3
3T
4/4T
5 (XXS)
6 (XS)
6x
7 (S)
8
10 (M)
12 (M)
14 (L)
16 (L)
18 (XL)
20 (XL)
Boys Shirt Size
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N/A
2T
3T
4/4T
5
6
7
7x
S (8)
M (10/12)
L (14/16)
XL (18/20)
Boys Bottom Size
*
N/A
2T
3T
3
4
5
6
7
7x
8
8 Slim
8 Husky
10
10 Slim
10 Husky
12
12 Slim
12 Husky
14
14 Slim
14 Husky
16
16 Slim
16 Husky
18
18 Slim
18 Husky
20
20 Slim
20 Husky
Teen Girls Top/Dress Size
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N/A
0 (XS)
1/2 (XS)
3/4 (S)
5/6 (S)
7/8 (M)
9/10 (M)
11/12 (L)
13/14 (XL)
15/16 (XXL)
Teen Girls Bottom Size
*
N/A
3/4 (S)
5/6 (S)
7/8 (M)
9/10 (M)
11/12 (L)
13/14 (L)
15/16 (XL)
24 (XS)
25 (XS)
26 (S)
27 (S)
28 (M)
29 (L)
30 (XL)
31 (XL)
32 (XXL)
33 (XXL)
Adult Men's Shirt Size
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N/A
S
M
L
XL
2XL
Adult Men's Pant Size
*
N/A
29W x 30L
29W x 32L
30W x 30L
30W x 32L
32W x 30L
32W x 32L
32W x 34L
34W x 30L
34W x 32L
34W x 34L
36W x 30L
36W x 32L
36W x 34L
Shoe Size
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Height
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Type of Cancer
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Approximate Date Diagnosed
*
MM slash DD slash YYYY
Status of Treatment
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Still in Treatment
Remission
Cancer-Free
Is Your Child Currently Undergoing Treatment?
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Yes
No
What Hospital and Oncologist did your child go to for treatment?
*
Do you need wheelchair assistance to get onto the stage?
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Yes
No
Please note any other accommodations.
*
What is your workplace?
Optional
Please provide the names of the 2 guests accompanying the featured model.
Guest 1 Name
*
First
Last
Guest 1 Phone
Guest 1 Email Address
Guest 2 Name
*
First
Last
Guest 2 Phone
Guest 2 Email Address
COVID and Photography Consent
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I agree to the privacy policy.
While participating in events held or sponsored by the National Pediatric Cancer Foundation, (“NPCF”) “social distancing” must be practiced and face coverings worn at all times in all indoor/enclosed spaces to reduce the risks of exposure to COVID-19. Because COVID-19 is extremely contagious and is spread mainly from person-to-person contact, NPCF has put in place preventative measures to reduce the spread of COVID-19. However, NPCF cannot guarantee that its participants, volunteers, partners, or others in attendance will not become infected with COVID-19.
In light of the ongoing spread of COVID-19, individuals who fall within any of the categories below should not engage in NPCF events and/or other face to face fundraising activities. By attending an NPCF event, you certify that you do not fall into any of the following categories:
1. Individuals who currently or within the past fourteen (14) days have experienced any symptoms associated with COVID-19, which include fever, cough, and shortness of breath, among others.
2. Individuals who have traveled at any point in the past fourteen (14) days either internationally or to a community in the U.S. that has experienced or is experiencing sustained community spread of COVID-19; or
3. Individuals who believe that they may have been exposed to a confirmed or suspected case of COVID-19 or have been diagnosed with COVID-19 and are not yet cleared as non-contagious by state or local public health authorities or the health care team responsible for their treatment.
DUTY TO SELF-MONITOR:
Participants and volunteers agree to self-monitor for signs and symptoms of COVID-19 (symptoms typically include fever, cough, and shortness of breath) and, contact NPCF at 813-269-0955 if he/she experiences symptoms of COVID-19 within 14 days after participating or volunteering with NPCF.
LIABILITY WAIVER AND RELEASE OF CLAIMS:
I acknowledge that I derive personal satisfaction and a benefit by virtue of my participation and/or voluntarism with NPCF, and I willingly engage in NPCF events and/or other fundraising activities (the “Activity”).
RELEASE AND WAIVER.
I HEREBY RELEASE, WAIVE AND FOREVER DISCHARGE ANY AND ALL LIABILITY, CLAIMS, AND DEMANDS OF WHATEVER KIND OR NATURE AGAINST THE NATIONAL PEDIATRIC CANCER FOUNDATION AND ITS AFFILIATED PARTNERS AND SPONSORS, INCLUDING IN EACH CASE, WITHOUT LIMITATION, THEIR DIRECTORS, OFFICERS, EMPLOYEES, VOLUNTEERS, AND AGENTS (THE “RELEASED PARTIES”), EITHER IN LAW OR IN EQUITY, TO THE FULLEST EXTENT PERMISSIBLE BY LAW, INCLUDING BUT NOT LIMITED TO DAMAGES OR LOSSES CAUSED BY THE NEGLIGENCE, FAULT OR CONDUCT OF ANY KIND ON THE PART OF THE RELEASED PARTIES, INCLUDING BUT NOT LIMITED TO DEATH, BODILY INJURY, ILLNESS, ECONOMIC LOSS OR OUT OF POCKET EXPENSES, OR LOSS OR DAMAGE TO PROPERTY, WHICH I, MY HEIRS, ASSIGNEES, NEXT OF KIN AND/OR LEGALLY APPOINTED OR DESIGNATED REPRESENTATIVES, MAY HAVE OR WHICH MAY HEREINAFTER ACCRUE ON MY BEHALF, WHICH ARISE OR MAY HEREAFTER ARISE FROM MY PARTICIPATION WITH THE ACTIVITY.
ASSUMPTION OF THE RISK. I acknowledge and understand the following:
1. Participation includes possible exposure to and illness from infectious diseases including but not limited to COVID-19. While rules and personal discipline may reduce this risk, the risk of serious illness and death does exist.
2. I knowingly and freely assume all such risks related to illness and infectious diseases, such as COVID-19, even if arising from the negligence or fault of the Released Parties; and
3. I hereby knowingly assume the risk of injury, harm and loss associated with the Activity, including any injury, harm and loss caused by the negligence, fault or conduct of any kind on the part of the Released Parties.
MEDICAL ACKNOWLEDGMENT AND RELEASE. I acknowledge the health risks associated with the Activity, including but not limited to transient dizziness, lightheaded, fainting, nausea, muscle cramping, musculoskeletal injury, joint pains, sprains and strains, heart attack, stroke, or sudden death. I agree that if I experience any of these or any other symptoms during the Activity, I will discontinue my participation immediately and seek appropriate medical attention. I DO HEREBY RELEASE AND FOREVER DISCHARGE THE RELEASED PARTIES FROM ANY CLAIM WHATSOEVER WHICH ARISES OR MAY HEREAFTER ARISE ON ACCOUNT OF ANY FIRST AID, TREATMENT, OR SERVICE RENDERED IN CONNECTION WITH MY PARTICIPATION IN THE ACTIVITY.
As a participant, volunteer, or attendee, You recognize that your participation, involvement and/or attendance at any National Pediatric Cancer Foundation fundraising event or activity (“Activity”) is voluntary and may result in personal injury (including death) and/or property damage. By attending, observing or participating in the Activity, You acknowledge and assume all risks and dangers associated with your participation and/or attendance at the Activity, and You agree that: (a) the National Pediatric Cancer Foundation (b) the property or site owner of the Activity, and (c) all past, present and future affiliates, successors, assigns, employees, volunteers, vendors, partners, directors, and officers, of such entities (subsections (a) through (c), collectively, the "Released Parties"), will not be responsible for any personal injury (including death), property damage, or other loss suffered as a result of your participation in, attendance at, and/or observation of the Activity, regardless if any such injuries or losses are caused by the negligence of any of the Released Parties (collectively, the "Released Claims"). BY ATTENDING AND/OR PARTICIPATING IN THE ACTIVITY, YOU ARE DEEMED TO HAVE GIVEN A FULL RELEASE OF LIABILITY TO THE RELEASED PARTIES TO THE FULLEST EXTENT PERMITTED BY LAW.
PHOTOGRAPHY RELEASE: This “Release / Waiver”) is executed by the undersigned participant, volunteer, and /or parent and/or legal guardian (“Parent”) of each child and sibling listed below (“Child”) in favor of the National Pediatric Cancer Foundation (NPCF) and other Released Parties, as defined herein. For and in consideration of participation in the NPCF “Event”, it is acknowledged and agreed by the undersigned, for and on behalf of the Participant, Volunteer, Parent and Child, as follows:
The NPCF and other Released Parties may use, re-use, publish and re-publish any photos, videos or other likeness of the Participant, Volunteer, Child or the Parent taken at or in connection with the Event or any prior or subsequent event or activity sponsored or organized by the NPCF or other Released Parties (an “Other Event”), in whole or in part, separately or in conjunction with other photographs and video, in any medium now or hereafter known, and for any purpose whatsoever, including (but not by way of limitation) illustration, promotion, advertising and trade. The Participant, Volunteer, Parent/Guardian, on behalf of Parent and Child, hereby releases, waives and discharges the NPCF, its officers, directors, employees, agents, insurers, volunteers, contributors, sponsors and participating celebrities (collectively, the “Released Parties”) from any and all claims, demands, causes of action, suits, costs, or expenses or other liabilities of any nature, arising from or in any way connected with, directly or indirectly, the use by the NPCF or other Released Parties of any photographs and/or video of the Participant, Volunteer, Parent or Child taken at or in connection with the Event or Other Event, including, without limitation, any and all claims for libel and/or invasion of privacy. The parent/guardian of child understands that “apparel/costume assistance” maybe rendered by a volunteer or staff member. The Participant, Volunteer, Parent/Guardian hereby attest they have not been convicted of any statutory crime, nor any child-related offense &/or are not a registered child/pornography offender.
Please Type Name for Signature
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Upload Photos
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Accepted file types: jpg, png, gif, pdf, raw, jpeg, bmp, Max. file size: 5 MB, Max. files: 3.
Please upload a head shot and a full body shot of your child for our stylists. NOTE: Image will be used in our Event Program and On-Screen Presentation
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