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Congratulations

Congratulations

Morgan’s Legacy Gift Liability and Publicity Release Form

Required when approved for a gift. Allows for required uploads for proof of income and any denial letters from insurance.

"*" indicates required fields

Congratulations on being selected as a recipient in our Morgan’s Legacy Gift Program!

We are so pleased that your child has been selected to receive this gift!

We will be placing the order as soon as this completed form with all required documentation is received in our offices, please allow up to 14 days for processing.

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Name*
Child's full name
Email*
Parent's email address
Gift Requested*
Category applied for

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The following documentation is REQUIRED to make a final approval decision for your Morgan’s Legacy Gift request.

Please upload tax return(s) for 2021 for each earner in the household.
Drop files here or
Accepted file types: doc, docx, pages, pdf, Max. file size: 300 MB.
    Please upload denial letters from all insurances, Medicare and Medicaid if applicable. In the alternative, please upload documentation that this is not a covered item by insurance. If no proof is being submitted, please upload a statement detailing why.
    Drop files here or
    Accepted file types: doc, docx, pages, pdf, Max. file size: 300 MB.

      Section Break

      This Release is mandatory to be able to confirm your approval for a Morgan’s Legacy Gift.

      Consent*
      1. The undersigned hereby represents that I have requested that The M.O.R.G.A.N. Project, Inc., a Florida non-profit corporation, consider approval of my gift request on behalf of the child above named. I further represent that I have the sole and unconditional authority to execute all legal documents on behalf of, and am the legal guardian of, the above named child. I hereby represent that I have read, understand and agree to the Gift Guidelines that have been provided to me, and certify that the information contained in the attached Gift Application is true and correct.
      2. I hereby certify that the information contained in the attached documentation of proof of income is true and correct.
      3. I hereby certify that the information contained in the attached documentation of insurance denials is true and correct.
      4. As evidenced by my signature set forth below, and in consideration of The M.O.R.G.A.N. Project approving this gift application, I understand and agree that The M.O.R.G.A.N. Project, Inc., its agents, assigns and employees are not responsible for any claims, judgments, causes of action or damages arising out of or relating to the receipt, use, or enjoyment of this gift, and I hold them harmless from any such claims and agree to indemnify same in the event of any claim, judgment, or action. This agreement shall apply to all claims, which are made in the future by any third party as a result of the use and enjoyment of this gift.
      5. I give my consent for representatives of The M.O.R.G.A.N. Project, Inc. to use my child's name and/or picture to contact television, radio and newspaper media to do stories about my child’s gift for the purpose of increasing public awareness of their programs, goals and fundraising needs; I understand that my willingness to allow my child's name and picture to be used for publicity may help to facilitate the arrangements for our gift. However, my refusal to participate will not determine whether The M.O.R.G.A.N. Project, Inc. decides to approve or disapprove our gift request; I understand that this publicity agreement in no way affects my child's right to participate in the publicity campaign for any other organization; I am aware that videos and photographs may be taken during fulfillment of a gift by the parents/guardians or by representatives of The M.O.R.G.A.N. Project, Inc. or by news stations and press, individually and on behalf of the family members listed above, and hereby consent to be photographed and filmed without compensation. Photographs may be used for news articles, press releases, newsletters, social media channels and/or on the website for The M.O.R.G.A.N. Project, Inc.
      Please use a mouse or stylus to add your signature to this mandatory field.
      Reset signature Signature locked. Reset to sign again
      If you are open to us tagging you in our social media announcement of the Morgan’s Legacy Gift recipients please provide your information for Facebook, Instagram and Twitter
      MM slash DD slash YYYY
      This field is for validation purposes and should be left unchanged.

      themorganstage2022-08-29T21:37:45-04:00

      Providing therapeutic activities to individuals with developmental differences!


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      4100 N. Wickham Road
      Suite 107A-202
      Melbourne, FL 32935

      321-506-2707

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