The undersigned is the parent or legal guardian of (the “Participant”) and acknowledges the Participant is
under age 18 and desires to engage in a dream experience fulfillment activity (the “Activity”) of Believe in Dreams® (the
The undersigned further acknowledges that the Organization and its affiliates and assigns, and each of their directors, officers,
employees and agents and any of its or their respective heirs, executors, personal representatives and administrators,
successors and assigns (collectively, the “Releases”) may wish to publicize the name, likeness and other personal characteristics
and private information of the Participant for advertising, promotion and other commercial, business, and charitable purposes.
In exchange for the intangible value the Participant will gain by possibility of participating in the Activity and other good and
valuable consideration, the undersigned gives, on behalf of the Participant, permission for such use and publicity for such
purposes, according to the terms and conditions set forth in this Liability and Publicity Waiver and Release.
The undersigned, on behalf of the Participant, hereby irrevocably permits, authorizes and licenses the Releases to display,
publicly perform, exhibit, transmit, broadcast, reproduce, exploit, sell, rent, license, otherwise use and permit others to use the
Participant’s personal biographical information and other personal characteristics and private information set forth in this
Application and all materials created by the Releases that use any of the foregoing (collectively, the “Materials”) on a perpetual
basis throughout the world and in any medium or format whatsoever now existing or hereafter created, including, without
limitation, brochure and other print publications, advertising and other promotional materials, and the internet and for any
purpose, including, without limitation, advertising, public relations, publicity, packaging and promotion of the Organization and
its operations and charitable purposes without further consent from or royalty, payment or other compensation to the
undersigned or the Participant.
The undersigned also acknowledges and agrees that the Participant assumes full responsibility for any and all risks of bodily
injury, death, disability, and/or property damage as a result of participating in the Activity. The signature below indicates the
undersigned understands any and all risks involved in participating in the Activity and willingly and voluntarily accepts any and
all such risks on behalf of the Participant. By executing this release, the undersigned, on behalf of the Participant, releases the
Releases from any and all claims, actions, suits, causes of action, damages (direct, indirect or consequential), entitlements to
money or other property, accounts, covenants, agreements, representations (express or implied), express or implied warranties,
judgments, losses, liabilities and obligations of every kind whatsoever, in law or in equity, however arising, known and unknown,
expected or unexpected, including any and all attorneys’ fees and other expenses incurred in connection therewith which the
undersigned and/or the Participant now has, ever has had, or may incur or have against the Releases based upon, or arising out
of, or relating in any way to the Activity and/or the Releases’ use of the Materials.
The undersigned acknowledges that he/she fully understands the consequences of signing this release and that, by signing this
release, neither the undersigned nor the Participant is entitled to be compensated or otherwise reimbursed by the Releases for
any damages that may be incurred as a result of the Activity and/or the Releases’ use of the Materials.
The provisions contained herein shall be binding upon the undersigned and the Participant and his/her heirs, executors,
personal representatives and administrators, successors and assigns and shall inure to the benefit of the Releases.
This Liability and Publicity Waiver and Release and the construction and interpretation of the provisions hereof shall be
governed by the laws of the State of Ohio.
THIS LIABILITY AND PUBLICITY WAIVER AND RELEASE PROVIDES THE RELEASEES WITH AN ABSOLUTE AND
UNCONDITIONAL CONSENT, WAIVER AND RELEASE OF LIABILITY, ALLOWING THE RELEASEES TO PUBLICIZE
AND USE THE LIKENESS AND OTHER PERSONAL CHARACTERISTICS AND PRIVATE INFORMATION OF THE
PARTICIPANT AS SET OUT ABOVE. BY SIGNING, YOU ACKNOWLEDGE THAT YOU HAVE READ AND
UNDERSTOOD ALL OF THE TERMS OF THIS WAIVER AND RELEASE AND THAT THE PARTICIPANT IS GIVING
UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE RELEASEES.
By signing below, I acknowledge that acceptance of this application by Believe in Dreams® does not constitute a
commitment by the organization to fulfill the dream experience of the nominee. If the organization determines
that the dream experience of the nominee should enter the next stage of dream fulfillment, a representative will
contact the nominee (or nominator, if applicable) for more information and, if needed, supporting documentation.
I understand that submission of this application also does not constitute a commitment by the organization to
grant a dream experience to the nominee. Furthermore, I declare that all of the information in this application is,
to the best of my knowledge, true and accurate, and I agree to promptly inform the organization of any changes to
the information provided in this application.
Believe in Dreams® (the “Organization”) has been established and is operated exclusively for charitable purposes
within the meaning of section 501(c)(3) of the Internal Revenue Code of 1986, as amended (the “Code”). The
Organization focusses on children under age 18 who have suffered a personal or family trauma, financial or other
personal hardship that does not involve the child’s own medical condition. For example, these traumas and hardships
include extreme poverty, the death or serious illness of a parent, loss of housing, military deployment of a parent,
divorce or other life-changing event.
The Organization conducts its charitable activities in conjunction with professional sports team and local businesses.
Such events include: VIP attendance to sporting events, concerts, lessons or classes, visiting somewhere for the first
time, meeting or shadowing someone who inspires, coverage of costs for activities previously not attainable, or
material items to remove barriers from achieving a goal.
Children eligible for a Believe in Dreams® experience must have suffered a personal or family trauma or hardship
(such as those described above). Another requirement for eligibility is that the affected child, and his or her parent(s)
and/or legal guardian(s), must demonstrate financial need.
Eligible children will be granted a unique experience tailored to the responses on their application. Each Believe in
Dreams® experience is a unique, customized experience for the child (or children) involved and any accompanying
parent(s) or guardian(s). Each dream experience reflects a request from or interest of the child involved (as opposed
to parental interests) and is conducted in an age-appropriate manner. The Organization selects Believe in Dreams®
recipients utilizing the objective and nondiscriminatory process described below and provides appropriate logistical
support such as lodging, meals, transportation, tickets, pocket money and the like.
The Organization follows a process related to the application, qualification and granting of the Believe in Dreams®
experiences described above. First, the Organization accepts applications from educators, social workers, medical
professionals and the like and/or charitable partners such as the Red Cross, police and fire departments, hospitals,
the United Way and other social welfare entities. Second, once an application is submitted (which describes, among
other things, the personal or family trauma or hardship suffered by the child and the one or more Believe in Dreams®
experiences of interest to the child), the application is reviewed by the Board of Directors of the Organization (or by
a selection committee), and the application is approved or denied based on the eligibility criteria established by the
Board. Third, if a dream experience is granted, the nominator and family are notified and the Organization will work
with our Donors and Dream Granters to make the experience a reality.
The procedure for selecting Believe in Dreams® recipients described above is objective and nondiscriminatory. All
Believe in Dreams® recipients are chosen by the directors of the Organization or a selection committee. The directors
or the selection committee make decisions regarding who receives a particular dream experience based solely on
objective standards, including, but not limited to, financial need, application materials and other relevant information
and supporting documentation regarding a recipient. No individual who is a member of the Organization’s Board of
Directors, such committee or a “disqualified person” (as defined in section 4946 of the Code) with respect to the
Organization may be awarded a Believe in Dreams® experience from the Organization.
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