Gift of Time Together Application

The Gift of Time Together™ program is designed to provide meaningful experiences and moments of connection for families impacted by cancer and other life-threatening illnesses. To be considered for the program, please complete the application below.

Do you currently reside in the state of Ohio? *
Which best describes you? (Select all that apply) *
Is the individual currently: *
How were you referred to the Gift of Time Together Program *
Would your family be comfortable sharing parts of your experience publicly to help raise awareness for The CarsonStrong Foundation *

I understand and agree that my consent to these services is given in consideration of my being permitted to participate in the complementary services provided by the CarsonStrong™ Foundation. I acknowledge that I am a voluntary participant in these activities and assume full and complete responsibility for any injury, loss, or damage which may occur during my participation in these events hosted by the CarsonStrong™ Foundation. I hereby release and hold harmless the CarsonStrong™ Foundation, the 501©3 organization, and all employees, agents, and directors of the CarsonStrong™ Foundation for any and all claims, causes of action, suits, or other proceedings which in any way relate to my participation in the complementary services being offered by the CarsonStrong™ Foundation for personal injuries or any other damages sustained.

I understand and agree that by submitting this form it is simply an application, and I am in no way guaranteed to be selected to receive an experience from the Gift of Time Together program. I understand and agree that my application requires review by the CarsonStrong™ Foundation and if selected, I will be contacted by a representative of the CarsonStrong™ Foundation.