The Sisters Wish Application

Request A Wish

Please fill-out and submit the application. The individual who will receive the wish must be between the ages of 18-30 and be a resident of Maine, New Hampshire or Massachusetts to be considered.

Name

Age

Email Address

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number

What is your diagnosis and at what age were you diagnosed?

How would you describe yourself?

What have you learned about yourself since being diagnosed?

How would you describe your Best day?

What are some “Wish” ideas that you have?

Have you ever received a wish/gift from another organization? If yes, when and what was the gift?

How did you learn about The Sisters Wish organization?

Would you be willing to have your photograph appear on The Sisters Wish website & social media sites?

Signature

Date

AGREEMENT AND WAIVER

INTENDING TO BE LEGALLY BOUND, I have hereby signed this Agreement and Waiver

I, for myself and anyone entitled to act on my behalf, waive and release The Sisters'
Wish, and its representatives, directors, officers, employees, and sponsors from any and all
claims or liabilities of any kind arising out of my acceptance of a wish from The Sisters Wish.
I understand and agree that, in consideration of accepting a wish from The Sisters'
Wish, I and my heirs, personal representatives or assigns do hereby release, waive, discharge
and covenant not to sue The Sisters' Wish for any and all liability from any and all claims
arising from my participation in or acceptance of the wish. A Sisters' Wish shall not be liable
for any direct, indirect, incidental, special or consequential damages, resulting from the use
or inability to use the wish.
I agree to indemnify and hold The Sisters' Wish harmless from and against any and all
damages, costs, claims, or demands, including reasonable attorneys' fees, made by any third
party due to or arising from or relating to my acceptance of a wish for the violation of any
term of this Agreement and Waiver.
I grant permission to The Sisters' Wish to use any photographs, motion pictures,
recordings, or any other record of my acceptance or participation in the wish.
I agree that this Agreement and Waiver is intended to be as broad and inclusive as is
permitted by the law of the State of Maine and that if any provision of this Agreement and
Waiver shall be found to be unlawful, void, or for any reason unenforceable, then that
provision shall be deemed severable from this Agreement and Waiver and shall not affect the
validity and enforceability of any remaining provisions.
I agree that this Agreement shall be controlled by the laws of the State of Maine.
BY INDICATING MY ACCEPTANCE OF THIS AGREEMENT AND WAIVER, I HEREBY AFFIRM
THAT I HAVE READ AND UNDERSTAND THIS AGREEMENT AND WAIVER AND FULLY UNDERSTAND
ITS TERMS. I UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS, INCLUDING THE RIGHT
TO SUE. I ACKNOWLEDGE THAT I AM SIGNING THE AGREEMENT AND WAIVER FREELY AND
VOLUNTARILY AND INTEND BY MY ACCEPTANCE TO BE A COMPLETE AND UNCONDITIONAL
RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

Signature

Date