Programs

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Special Needs Ball

In partnership with United Cerebral Palsy, the Society, and the Valley Apprentice team created "A Night of Endless Possibilities: A Special Needs Ball", which was held June 18, 2011 at the Del Rio Golf & Country Club in Modesto with over 270 participants and volunteers. Dozens of vendors, table sponsors and donors helped make this evening possible by providing everything including the venue, décor, floral arrangements, lighting & sound, onsite medical staff, dresses, tuxedos, corsages & boutonnieres, hair styling, commemorative photos, dinner and dancing.

Special celebrity guest, Dot Marie Jones from the number one rated TV show GLEE, appeared to sign autographs and pose for photos.

One of the participants, Kaydie, said that she would like to dress up like Cinderella and dance with Prince Charming. There wasn’t a dry eye in the house when Dot Marie Jones introduced the young lady up front as Prince Charming knelt down to present her with a rose.

Randy and Patti Albracht, parents of attendee Whitney, said, "This has been the most exciting event of her life. She has been over the moon excited. You just don’t know what this means to her, and to us. Thank you!" Celebrity guest Dot Jones agreed: "I’m coming back next year, and next year I’m going to sing!

If you would like to be a part of this magical evening, Please click on the pre-register link and fill out the interest form.

If you have any questions, please contact the Society at 209.524.3536 or email us at Programs@societyforhandicapped.org.

To sponsor this event, Click Here

Guest Pre-Registration

To register for the Special Needs Ball, please fill out the guest pre-registration form

Pre-Registration Form

Name:
Parents Name:
Address:
City:
State:
Zip:
Phone: (You will be contacted by SHCA staff with instructions for event registration)
Age:
Gender:
Email:
Confirm Email:
Disablility:
Special Diet:
Medical/Restroom Needs:
Allergic Reactions:
Other Needs:
Special Wish: (only select wishes will be granted)
Do you need a host/hostess for the ball?

Host Name: Date/buddy must register as well.

Participant/ Volunteer Photo Release Waiver and Release of Liability

Society for Handicapped Children and Adults
Night of Endless Possibilities Special Needs Ball
Participant/ Volunteer Photo Release Waiver and Release of Liability
I submit that myself or my child to be allowed to participate or volunteer in the “2012 Special Needs Ball; A Night of Endless Possibilities”, and agree to the following:
1. I acknowledge and fully understand that me or my child as a minor or dependent participant will be engaging in this activity and I also acknowledge that there may be risks not known to me or not reasonably foreseeable at this time.
2. I assume all the foregoing risks and accept personal responsibility for the damages following such as injury, permanent disability, or death. 
3. Myself and my family release, waive, discharge and promise not to sue Society for Handicapped Children and Adults, United Cerebral Palsy, Del Rio Country Club, its’ volunteer instructors and directors, related staff, executive directors, board of directors, and other participants of the “2012 Special Needs Ball: A Night of Endless Possibilities”  for any personal injury, property damage, or other damages that may arise from my participation in “2012 Special Needs Ball: A Night of Endless Possibilities”, regardless of whether such injury or damage is caused by negligence or carelessness of the “2012 Special Needs Ball: A Night of Endless Possibilities”  event.   
4. I agree that photographs and/or my name, and/or my child’s name, may be published or used by Society for Handicapped Children and Adults and any of the media or mass communication (including newspapers, magazines, television, pamphlets, brochures, newsletters, reports, etc.) without any liability on the part of Society for Handicapped Children and Adults, United Cerebral Palsy or Del Rio Country Club. 
5. I have talked to my physician, who has acknowledged, that my child/me is physically capable to engage or volunteer in such an event.  I have given an accurate description of any disability and medical needs on the “2012 Special Needs Ball: A Night of Endless Possibilities” application. 
6. I agree that the staff and volunteers of the “2012 Special Needs Ball: A Night of Endless Possibilities” and Society for Handicapped Children & Adults of Stanislaus County, United Cerebral Palsy, and the Del Rio Country Club may authorize emergency medical treatment for me, or for my child, up to and including emergency hospitalization and surgery.  I give the above noted organizations and volunteers’ the right to determine the appropriate medical facility/provider in the absence of a parent.  I agree to be personally responsible for any related medical expenses. 
7. I understand that not all wishes will be granted. Although we would like to grant every wish, only a select few will be chosen. 
By filling out this form you understand this is not a guarantee of registration of the 2012 Special Needs Ball. All applicants will be contacted by staff with further registration requirements – SPACE IS LIMITED
I/WE HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I/WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, HAVE NOT CHANGED IT ORALLY, AND SIGN IT VOLUNTARILY.

Check box to agree. Your request for registration will not be complete unless this box is marked.

Volunteer

To volunteer for the Special Needs Ball, fill out this volunteer form

Volunteer Registration Form

Name:
Parents Name:
Address:
City:
State:
Zip:
Phone: (You will be contacted by SHCA staff with instructions for event registration)

Email:
Confirm Email:
Age:
Gender: