Nominate a Child

KIDSgala Overview and Eligibility

KIDSgala began in 2013 with the following mission, “A foundation created in the memory of Nicole Marie Burton, to provide a gifted celebration to children who have or are battling a life altering event. KIDSgala is dedicated to hosting events that will individually celebrate each child’s life achievements…”

Any family or social worker with a child that identifies with the mission of the foundation can apply. We do, however, request that the following criteria be met:

The child should be between the ages of 3 – 17 at the time of the celebration.
The child must have or is battling a life altering event.
Written approval from primary care physician, nurse practitioner, or physician assistant that clears child to attend event.
Referral letter from child’s social worker.
A completed and signed Photo Release Form. (Download using link below.)
Must be accompanied to the event by parent, legal guardian and/or social worker.
Provide own transportation to and from celebration event.
Must reside in Livingston, Macomb, Oakland, Washtenaw or Wayne counties.
Gifted celebrations are limited to 50 guests including child and immediate family.

KIDSgala Application

Child's Name *

Date of Birth *

Parents' Name(s) *

Email Address of Person Applying *

Email of Nominated Child's Parent/Guardian *

Phone *

Address *

City *

Zip *

Description of Illness, Disability or Accident *

Physician Name/Address/Contact Number *

Date Last Seen by Physician *

Name of Immediate Family Member or Social Worker Submitting Application *

Relation to Child Applicant *

Date *

How Did You Hear About Us? *

Photo Release

By signing this release form, I authorize, KIDSgala, a David C. McKnight Foundation and 501(c)3 nonprofit organization (hereinafter “KIDSgala”), to use photographs, video images and recordings of me/us at the KIDSGala Event

I hereby grant to KIDSgala, its subsidiaries, licensees, successors and assigns, the right to use, publish, and reproduce, for all purposes, including, but not limited to, marketing, promotion, communication and advertising; my name, pictures of me in photographs, video images and recordings in either printed or electronic form.

I further grant KIDSgala all right, title and interest that I may have in all pictures, reproductions and copies of the original print, and further grant KIDSgala the right to exhibit copies for marketing, communications or advertising purposes as it deems fit.

I hereby waive the right to receive any payment for signing this release and waive the right to receive any payment for the use of any of the material described above for any of the purposes authorized by this release by KIDSgala. I also waive any right to inspect or approve photographs, video, printed material or other electronic media that may be used in conjunction herewith or to approve the eventual use.

I acknowledge that I have read the foregoing and I fully understand the contents. I have executed this Release on the date below:

Date

Signature

Clear

Name

First

Last

Select if this release is provided on behalf of a child

Section

I hereby certify that I am the parent or legal guardian of

Child's Name

First

Last

who is a minor, under the age of eighteen (18) years, to whom this release applies and that I have the legal authority to execute this release. I approve the foregoing and agree that we both shall be bound thereby. I acknowledge that I have read the foregoing and have had ample opportunity to consult legal counsel of my choosing and I fully understand its contents. I have executed this release on

Date

Parent/Legal Guardian Signature

Clear

Parent/Legal Guardian Name

First

Last