New Membership Application and Registration

New Membership ONLY

New Membership ($85.00)

Member's Name

Nickname

Date of Birth

Address

Member Phone Number

Member Cell Number

Member Email

Member's Disability

Ethnicity

Parent or Guardian Information (If Applicable)

Name

Address

Home Phone Number

Cell Phone Number

Work Phone Number

Other Family Members Registering

Name

Relationship

Name

Relationship

Name

Relationship

Member Signature

Your signature indicates the Member Information above is correct.
The information listed will be added to the North Texas SNAP, Inc. database.

I, the undersigned, agree to the terms above.

Parent Signature

Your signature indicates the Member Information above is correct.
The information listed will be added to the North Texas SNAP, Inc. database.

I, the undersigned, agree to the terms above.

How did you hear about SNAP?

Social/Recreational Activity Involvement

Parent Involvement

North Texas SNAP VOLUNTEERS are the heart of our organization and we make every effort to provide you with a variety of opportunities to get involved and utilize your gifts. We depend heavily on volunteers to help with programs, social activities and special events. Thank you for your time and commitment in helping make NTX SNAP all it can be for our wonderful members!

Parent Availability

Hours Available:

Morning 8:00 a.m. - Noon
Afternoon Noon - 5:00 p.m.
Evening 5:00 p.m. - 9:00 p.m.

EMERGENCY TREATMENT RELEASE

Signature of Participant

I authorize the person in charge to seek and obtain on my behalf emergency medical treatment. I also authorize transportation to the nearest medical facility in the event it should become necessary.

I, the undersigned, agree to the terms above.

Signature of Parent/Guardian

I authorize the person in charge to seek and obtain on my behalf emergency medical treatment. I also authorize transportation to the nearest medical facility in the event it should become necessary.

I, the undersigned, agree to the terms above.

PUBLICITY RELEASE

Signature pf Participant

I hereby give my permission for the use of photographs or videos of myself and my family members to be used for the purposes of promoting or representing North Texas SNAP.

I, the undersigned, agree to the terms above.

Signature of Parent/Guardian

I hereby give my permission for the use of photographs or videos of myself and my family members to be used for the purposes of promoting or representing North Texas SNAP.

I, the undersigned, agree to the terms above.

DONATIONS

Donations to North Texas SNAP helps fulfill the organization’s mission to “Create and support a variety of programs that assist individuals 17 and older living with intellectual disabilities in achieving and sustaining full lives.”

Processing Fee

$2.50

Total

$87.50

Billing Information

Name

Payment Method

Credit Card
Check

Credit Card

Visa
Mastercard
American Express
Discover

Address