Do you have a special reserved flight code?  All codes expired April 2, 2010, but please enter your code if you have one.     If you don't have a reserved flight code, no worries: just leave this blank and continue. From which organization did you hear about Day in the Sky?   Example: Easter Seals, Make A Wish, etc. Child with Special Needs' Information Note: Flights are reserved for children with special needs (disabilities, critical illnesses, etc) and TWO guests each.  Guests need not have special needs, but the primary young person must have a special need to qualify. Participating Disabled or Challenged Child's Name: *rqd Child's First name:     Child's Last name: Has the child flown in a Day in the Sky before? Yes When/Where: No Desired Flight SCHOOL Time: *rqd --Chose one-- First Available 10:00 AM 10:15 AM 10:30 AM 10:45 AM 11:00 AM 11:30 AM 1:00 PM 1:15 PM 1:30 PM 1:45 PM 2:00 PM 2:15 PM 2:30 PM 2:45 PM Desired Flight School Time Flights will be approximately 15 minutes to 1 hour after flight school times. Warning: To prevent overcrowding, you will not be allowed into flight school before your scheduled time. Note: You will attend a 15 minute flight school before flying to familiarize you with the aircraft.  Your actual flight time will depend on weather, numbers of pilots, numbers of participants, and many other factors.  If a time is not shown, the flight school is full.  We might have to change your requested flight school time depending on how full each class is.  Flight school instrustors and most pilots speak English. We will try to locate bi-lingual instructors and pilots if possible, and if desired.  Please select your young person's language preference The young person understands English The young person would prefer Spanish flight schools & pilots The young person would prefer another language if possible:        Other language: Note: We cannot guarantee bilingual speakers, but we will do our best to accommocate your young person's needs. Child's Birthday & Age: Note: You must enter the child's birthday, and you must enter the child's age to confirm.  Note, flights priority is given to young people between the ages of 6 and 17.  If extra flights are available, other ages might be able to fly. *rqd: Month:    *rqd Day   *rqd Year: -choose- January February March April May June July August September October November December -choose- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 -choose- 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 *also rqd: Child's age: years Note: birthday and age must match so we can confirm eligibility. Height and Weight. *rqd ft,   *rqd inches     Weight:*rqd (pounds) All information is required so we can assign loaders and airplanes properly. Street Addr: *rqd City: *rqd     State: -select- (Not Applicable) Alaska Alabama Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Guam Puerto Rico Virgin Islands AA - Armed Forces Americas AP - Armed Forces Pacific AE - Armed Forced Europe *rqd Zip:  *rqd Email: *rqd  Note:You MUST enter an email address that you check frequently. All confirmations and flight times will be sent to this email address.  Please enter an email address that you check often, or you might miss important confirmation information from us. Phone: *At least one phone number is required so we can reach you if we have questions. Daytime:   Evening: (Don't forget your area code.) T-shirt Size (Adult Sizes) *rqdXL  L  M S Disability:  All information you provide will be strictly confidential and is only required so we can serve the children better.  Please select or describe the child's disability so we can be prepared to meet the child's needs. *rqd Note: Flights are reserved for young people with disabilities and critical illnesses. Two guest passengers need not have a disability or illness, but the primary young person must have a disability or critical illness. Blind   Cancer Cerebral Palsy Deaf Spinal Cord Spina Bifida MS Downs Syndrome Autism ADHD Epilepsy Hydrocephalus Developmental Delay Multiple Sclerosis Muscular       Dystrophy Other:     Other special needs and disabilities are considered if extra seats are available. Is the child ambulatory? *rqd so we can make special accommodations if necessary. No mobility issues. Uses wheelchair Uses cane/crutches/similar     Please describe any special transfer or loading issues we should know about.      Parent or Guardian Name: *rqd  Must be over 18 and parent or legal guardian.

Optional: Select a first guest flier (optional) Each disabled young person may invite up to two guests to fly.  Guests can be friends, family, or anybody the child desires.  If any passenger needs an adult caregiver on board, we will allow 18+ adults to fly.  However, we strongly prefer that seats be reserved for young people 8-17.  Free flights are based on availability and are subject to limitations.  If you do not specify a guest, we reserve the right to assign appropriate guests to accompany your child. Since we want as many young people to fly as possible, we prefer that one adult and one child accompany the young person with special needs.  Mother/brother, father/sister, caregiver/friend etc are great combinations.  We will accept 2 adult guest fliers or 2 young people guest fliers if you desire. Guest Flyer #1: Birthday: Month: January February March April May June July August September October November December  Day  Year:       Age: years Relationship to Participating Child: Select One Aunt Brother Caregiver Cousin Father Friend Grandfather Grandmother Great Grandfather Great Grandmother Mother Half Brother Half Sister Nephew Niece Occupation Therapist Recreation Therapist Sister Staff Step Brother Step Sister Step Father Step Mother Teacher Twin Brother Twin Sister Uncle Other (please describe) Other: Street Addr: City: State:    Zip:   Email: Phone: Daytime:   Evening: (Don't forget the area code.) Parent or Guardian Name of Guest Flyer #1 (rqd if under 18)

Optional: Select a second guest flier (optional) Each participating young person may invite up to two guests to fly.  Guests can be friends, family, or anybody the child desires. If any passenger needs an adult caregiver on board, we will allow 18+ adults to fly.  However, we strongly prefer that seats be reserved for young people 8-17.  Free flights are based on availability and are subject to limitations.  If you do not specify a guest, we reserve the right to assign appropriate guests to accompany your child. Since we want as many young people to fly as possible, we prefer that one adult and one child accompany the young person with special needs.  Mother/brother, father/sister, caregiver/friend etc are great combinations.  We will accept 2 adult guest fliers or 2 young people guest fliers if you desire. Guest Flyer #2:   Birthday: Month: January February March April May June July August September October November December  Day  Year:   Age: years Relationship to Participating Child: Select One Aunt Brother Caregiver Cousin Father Friend Grandfather Grandmother Great Grandfather Great Grandmother Mother Half Brother Half Sister Nephew Niece Occupation Therapist Recreation Therapist Sister Staff Step Brother Step Sister Step Father Step Mother Teacher Twin Brother Twin Sister Uncle Other (please describe) Other: Street Addr: City:   State:    Zip:   Email: Phone: Daytime:   Evening: (Don't forget the area code.) Parent or Guardian Name of Guest Flyer #2 (rqd if under 18)

Comments.  Any special medical concerns we need to be aware of?  Anything else you would like to share with us?  Has the child flown before? What inspired the child to want to fly with us? Any interesting stories about the child's guest fliers?  The more you can tell us, the better prepared we can be to make the child's day as memorable as possible

The Young Eagle candidate(s) named above wishes to participate in the Day In The Sky / EAA Young Eagle's program, which includes a demonstration flight.  I certify that I am the child's legal guardian, and I give him/her permission to participate in this program.  I also agree to voluntarily release, waive and relinquish any and all claims I or my child may have against Shared Adventures, the Experimental Aircraft Association, Inc., The Watsonville Airport Authority, The EAA Aviation Foundation, Inc., and all participants and sponsors for any and all claims which may result from participation in any part of this program.  I further agree to hold harmless the aforementioned individuals and entities for any and all claims which may result from participation in any part of this program. By participating in the Day in the Sky program, I also consent and authorize Shared Adventures and EAA, and its successors, legal representative and assignees to use and reproduce my child's name, and photograph(s) and circulate the same for any and all purposes including public information of every description.  receipt of full consideration of each participant is hereby acknowledged and no further claim of whatsoever nature will be made by me.  No representatives have been made by me. By submitting this application online, I certify that I am 18 years of age or older, and that all information presented is accurate.  I also agree to all terms and conditions set forth by Shared Advnetures and EAA, and its successors, legal representative and assignees. You will also be required to read and sign a "EAA Young Eagles Registration Form" on site.  You do not have to sign the form now, we will have copies to sign at registration. Name of person submitting this application (must be parent or guardian over 18 years old):     *rqd

Note: Submitting this application does not guarantee space on a demonstration flight.  Space is limited.  Typically, no young persons are turned away because of disability, however, all participants must meet our essential eligibility requirements.  If you have any questions about restrictions, please contact us at dean@dayinthesky.org.  We reserve the right to refuse service to anyone. We will send you a confirmation email with more information as soon as your application is received.  If you do not hear from us before the event, please assume that you are registered and plan to arrive at the airport at 9am or at least 1/2 hour before your selected flight school time on Saturday April 17, 2010.   Note: we will have pre-printed waiver forms for you to sign on the day of the event, so there is no need to fax or mail anything to us once you complete this online application.           We reserve the right to deny service to anyone for any reason at our sole discretion. Please click once and allow up to 45 seconds for our computers to respond once you submit this application.

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Questions?  Email: info@dayinthesky.org 
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