Warrior Sign Up

How Else Can We Help?

Phone *

The Battle *

Is there any additional information we need to know/you would like to share?

If Other, Please Explain

Warrior's DOB *

Warrior's Siblings and DOB

Allergies *

Favorite Things to Play *

Battle Status *

In Treatment

Out of Treatment

Remission

Other

Email *

Gender *

Male

Female

Consent/ Release- Social Media, Print, Publicity, Printed & Electronic* *

I AGREE and hereby grant full permission to Kid's Day of Lexington/Olly Otter to use either myself or my child/children’s name(s) and photograph in any publication or advertising materials (printed or electronic), and social media. This consent serves to waive all rights of privacy or compensation which I may have in connection with the use of my photograph and/or my child’s photograph or name. IF YOU AGREE, be sure to follow our social media sites to see your child’s story featured!

I DO NOT AGREE to have mine or my child/children’s name(s) photograph used for public viewing.

Mailing Address

Warrior's Interests *

Parent/Guardian 2

Warrior's Name: *

Address 1 *

Parent/Guardian 1 *

Olly's Warriors Registration Form