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Application - Seasons of Giving

ThermoSpas Seasons of Giving Application

Please fill out the entire form to the best of your abilities. * Indicate required fields. Any fields left empty may require us to contact you for further information.


Please Confirm that you you have read the "How to Apply" first, if not please read this section. It is very important to the application process.
I have read "How to Apply"

Child's Background Information
First Name: * Last Name: * Date of Birth:* Age:*
Address: * City: State: Zip code:
Phone Number: *
Email Address for Mother: Email Address for Father:
Cell Phone for Mother: Cell Phone for Father:
Work Phone for Mother: Work Phone for Father:



Parents or Guardians:
Mother's Name: * Mother's Date of Birth: Mother's Address: Mother's Phone:

Father's Name:* Father's Date of Birth: Father's Address: Father's Phone:
Marital Status of the Parents (Check one of the following):
Married Single Divorced Seperated

If divorced, seperated, or single is checked, please indicate whether the father, mother, both parents, or a third party has legal custody of the child.
Who has custody of the child?

How did you find out about the Seasons of Giving hot tub donation program?
Brothers & Sisters
List all brothers and sisters under 18 years of age from oldest to youngest:
Child 1 Information
Child 1 Name: Date of Birth: Age: Living at home: Illness if any:
Child 2 Information
Child 2 Name: Date of Birth: Age: Living at home: Illness if any:
Child 3 Information
Child 3 Name: Date of Birth: Age: Living at home: Illness if any:
Child 4 Information
Child 4 Name: Date of Birth: Age: Living at home: Illness if any:

Medical Information:
Child's Diagnosis: * Primary Physician's Name:*

Address:
Phone Number: * Fax Number:

Please Describe Your Child's Condition: *


Please describe your child's special medical needs (for example, is your child confined to a wheelchair, in need of 24 hour nursing care, require certian equipment, etc.):*

Please explain why a hot tub would be beneficial to your child's condition:*

Your Child's Dream:
Please describe an average day in the life of your child:*


Please explain more about your child as a person (for example, his/her likes and dislikes, family life, history, etc.):*


Please explain why your child would like a hot tub:*


Please tell us anything relevant about your child that we have not asked: