Application for Membership in Reagan’s Journey, Inc.


The establishment of an account for the purpose of the disbursement of funds to benefit of Reagan’s Journey children. consists of an application and parental/legal guardian written agreement to the guidelines set forth in this application. Upon receipt of the completed application, Reagan’s Journey will review the information provided and if necessary, verify said information. However, approval of the application does not depend solely on the provided information as other circumstances may apply. There is no cost to a member’s family for their child to become a Reagan’s Journey member.

By awarding finances, Reagan’s Journey Inc. is making no recommendation as to the appropriateness or safety of a particular service for a member. Reagan’s Journey Inc. is not responsible for the safety and/or progress of any member. Each family is strongly urged to consult with their physician (s) and therapist (s) regarding the choice and use of a particular service, equipment or any other therapeutic intervention. If a members request for funding exceeds the available funds of their account with Reagan’s Journey, the request may be tabled until such time as more funds become available or partial funds may be awarded at the time of the request. Any requests exceeding $1,500.00 must be approved by the Board of Directors.

Member’s families are encouraged to keep their child’s profile and journal entries current on the website. Monies can be donated in honor of one specific child. All funds go into the general account established to be distributed to all families as needs arise. Reagan’s Journey is committed to help all families reach the financial milestones set to obtain the therapies and equipment needed for the best interest of their child’s progress.  There is a small processing fee (charged by PayPal) applied to donations online.

The request for verification form must be signed by the member’s primary Physician or Therapist in order to verify the member’s diagnosis and need for intervention. The request for verification form needs to be returned to Reagan’s Journey in order for funds to be released to a member for the first time. The application must be filled our completely before a child can be accepted and added to the website. Parents/legal guardians are asked to write their child’s profile for the website and their first journal entry. Reagan’s Journey volunteers are available to assist in this process if needed. Once the first journal entry is loaded, the child’s picture will appear, in addition to on their own page, on the scrolling member’s photos on the first page of the website.

The information of this application will be handled with respect and confidentiality. At no time will Reagan s Journey release any of the applicant’s information except with permission for purposes of the Reagan’s Journey website, events and/or advertising. The online journals on the Reagan’s Journey website are the responsibility of the parent (s)/legal guardian of the member. The member’s profile and photos are submitted by the member’s parent (s)/legal guardian.

You may apply by submitting an online application below. You may also print the application and sent it to:

Reagan’s Journey, Inc.
249 Vine Street,
Kittanning, PA 16201

 

Apply On Behalf of Child

After you submit the application for your child, please print and return to us the Request for Verification form to confirm your child’s diagnosis with your health care provider.

* Fields marked with * must be filled out

Applicant's address if not the same as parent/guardian:

Separate applications are required for each child

Please read our Terms & Conditions

Due to the volume of applications and staff limitations, status reports are not provided during the application process. Incomplete applications will not be reviewed. All decisions made by the Board of Directors are final.

By submitting this application you attest that the information you have provided in this application is factual and true to the best of your knowledge and you indemnify and hold Reagan’s Journey and/or its staff or volunteers from any and all liability, claims, damage or injury sustained by the Applicant or his/her family and/or caregivers.

Reagan’s Journey uses its website and social media to allow the parents/guardians of the children involved to publish the progress and needs of the child (ren). Your child will have an online account in order to share progresses, challenges and moments of wonder! Reagan’s Journey would like you to document your challenges and your success stories. Your experience may benefit another family. You will be encouraged to journal their experiences and upload pictures to share with our supporters.

By signing this agreement, you are giving Reagan's Journey Inc. permission to use photographs and/or your child’s likeness on its website as well as in promotional and advertising mediums including but not limited to online, social media, promotional products, news coverage and event promotions. You agree to follow the Reagans Journey guidelines of participation. You agree to hold harmless Reagans Journey Inc. and its affiliates from any possible adverse events resulting from your child’s membership.

Electronic Signature

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