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Home
Our Program
Our Impact
About Us
Our Team
Latest News
Spotlights
FAQ
Get Involved
Corporate Giving
Volunteer
Live Again Retreat
Events
Host a Pay-It-Forward Event!
The Finley Project Shop
Buy "More than I'm Sorry" Book
Buy "More than I'm Sorry" Care Guide
Donate
Contact Us
Contact Us
Live Again Retreat Application Form
Live Again Retreat Agreement Form
Gala Sponsorship Form
Program Application
Program Forms
Board Forms
Know Moore Consulting
Father Support Opportunity Application
Father's Name
*
First Name
Last Name
Father's Age
Optional
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email
*
Emergency Contact #1
*
First Name
Last Name
Emergency Contact #1
*
(###)
###
####
Emergency Contact #2
*
First Name
Last Name
Emergency Contact #2
*
(###)
###
####
Mother/Partner's Name
*
Mother/Partner must have been a Finley mom prior.
First Name
Last Name
Child's Name
*
First Name
Last Name
Child's Birth Date
*
MM
DD
YYYY
Date of Loss
*
MM
DD
YYYY
Do You Have Any Other Children?
*
Yes
No
If you have other children, please list them & their ages below
When Were You a Finley Dad?
*
Your Story
*
Please use the space below to share your story of loss.
I understand that my support coordinator does not take the place of a professional mental health counselor and release, waive, and forever discharge The Finley Project®, its Board of Directors and its officers, agents and employees, from any and all liability, claims, demands, actions, or causes of actions arising out of or related to my participation in The Finley Project® program. In no event shall The Finley Project® be liable for any incidental, consequential, indirect, statutory, special, exemplary or punitive damages, including, but not limited to, lost profits, loss of use, loss of time, inconvenience, loss business opportunities, damage to goodwill or reputation, or other economic loss, regardless of whether such liability is based on breach of contract, tort, strict liability or otherwise, and even if advised of the possibility of such damages or such damages could have been reasonably foreseen.
*
I agree
I shall indemnify, defend, and hold harmless The Finley Project®, its Board of Directors and its officers, agents and employees from any loss, liability, damage, or expense including reasonable attorneys’ fees and costs from any claim that may arise from or in connection with my participation in The Finley Project® program. If I fail to promptly indemnify and defend a covered claim, The Finley Project® shall have the right to defend itself, and in such case, I will promptly reimburse The Finley Project® for all of its associated costs and expenses.
*
I agree
Media Consent - Please initial below if you give The Finley Project® the right and permission to record, create, and use personal quotes, pictures, and audio and video recordings of you on The Finley Project® website, social media platforms, and other materials about the Program (“Media”). By initialing below, you waive any rights to the Media and acknowledge that the Media is the sole and exclusive property of The Finley Project, and all right, title, and interest therein shall vest in The Finley Project. You also agree to release, discharge, and indemnify and hold harmless The Finley Project and their agents from all claims, demands, and causes of action that you have or may have by reason of this authorization or creation and use of the Media. The Finley Project® will notify you before using any Media of you and obtain approval for such use in advance of publishing or posting the Media.
*
I represent that I am at least eighteen (18) years of age and am fully competent to sign this agreement. This agreement shall (i) be binding upon me and my agents, representatives, assigns, heirs, and successors in interest; (ii) be governed by and construed in accordance with the laws of the State of Florida without giving effect to any choice or conflict of law provision or rule; and (iii) any and all claims arising out of or relating to this agreement shall be brought in a state or federal court of competent jurisdiction in Orange County, Florida. I consent to the personal jurisdiction of the state and federal courts located in Orange County, Florida. I waive (a) any objection to jurisdiction or venue, or (b) any defense claiming lack of jurisdiction or improper venue, in any action brought in such courts.
*
I agree
Form completed by:
*
First Name
Last Name
Thank you!