Parent Guardian Name(s) *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Method of Communication *

Email

Phone Call

Text

Champion Child's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Participation Interests *

Which types of events or roles would you be interested in as a Champion Family?

Family Days

Dance Marathon

Social Media Features

Interviews (Video or Audio)

Preferred Level of Involvement *

Very Involved (e.g., attending events, public speaking, interviews)

Moderate (e.g., event attendance, sharing updates on social media)

Low (e.g., occasional check-ins or story-sharing)

Would you like Family Pals this year? *

Family Pals are a few of our incredible Family Relations committee members who are so excited to get the opportunity to get to know you and your family as well as love on and champion your children. We have hundreds of people wanting to join our committee every year, so these students understand that it is an honor and privilege to be a part of your lives! These students are here to spend time with your family at Miracle events such as our Family Days, Dance Marathon, etc. If you so choose, they can also support your child at games, recitals, etc. and/or meet for a meal once in a while! The level of involvement with your Family Pal is totally up to you!

Yes

No

Would you like to be added to the new "UGA Miracle Families" Facebook Group? *

If so, look for a friend request from us!

Yes

No

This year, we want more committees to get an opportunity to meet and form bonds with our families. *

Would you want to be contacted about possibly speaking at a committee meeting or some other fun Miracle events?

Yes

No

Media Release Consent *

I consent for UGA Miracle to use photos, videos, and testimonials of my family for promotional purposes

Agreement to Participate *

I understand that by becoming a UGA Miracle Champion Family, we will represent UGA Miracle in various events and communications to help promote awareness and fundraising efforts