Virtual Laughter Muscle Dream Programme – Applications Now Closed

The Muscle Help Foundation charity’s much anticipated Virtual Laughter Muscle Dream Programme on Tuesday 22nd December is here! NOTE: the application process to participate on this programme is now closed.

  • Be sure you wear your favourite Christmas jumper
  • Bring your best ever joke
  • Help make our Chief Muscle Warrior laugh-out-loud

WHAT’S INCLUDED?

All participating families will receive:

  1. One magical Muscle Dream Christmas gift package per beneficiary– with an item that will encourage everyone to laugh together, plus a £50.00 gift voucher (select from the drop-down menu below in the application form).
  2. Delivered via Zoom and supported by Laughtercise, we’ve come up with a cunning plan, an immersive .60mins therapeutic experience like no other to lift spirits, lighten the mood and set us up for a Christmas filled with joy.
  3. Personalised certificate from Laughtercise who work with the NHS and many of the UK’s ‘Best Companies’ – unsurprisingly, demand for their wellness activities due to the pandemic is high. Laughing muscles will be stretched, hearts warmed, and minds calmed just before the festive period kicks-off!
  4. A little treat pre-Christmas from us – you order in your family’s fav take-away (for up to 4 people), a feast of your choosing. Complete the charity’s reimbursement form here afterwards (before 31st Dec 2020) and we will take care of the rest up to the value of £60.00 per family ~ bon appétit!

COMPLETE ALL SECTIONS BELOW:

Section One: Muscle Dream Beneficiary Information

Section Two: Liability Release & Disclosure

Section Three: GDPR Contact Permission + Preferences

Should you have any questions regarding the completion of this application form, please contact: info@musclehelp.com – thank you.

    SECTION ONE = Muscle Dream Beneficiary Information

    Virtual Muscle Dream Beneficiary

    Information about Muscular Dystrophy

    Beneficiary Address + Contact Details

    Indicate below where you heard about the Muscle Help Foundation (MHF) charity

    From another familyWord of mouthAnother Muscle Dream recipientFundraising eventInstagramHospiceFacebookTwitterMHF charity leaflet

    Favourite Take-Out

    What is you and your family’s favourite take-out meal?

    Household Technology

    Will you be able to participate in a standalone video conferencing call on Zoom, the platform being used for this virtual Muscle Dream programme?

    Do you have a computer / desktop / laptop / smartphone?

    Virtual laughter Muscle Dream - Gift Card / Voucher Options (£50 value)

    In the menu below, select your preferred option. You will only be able to choose one from the list below:

    SECTION TWO = Liability Release & Disclosure

    The Muscle Help Foundation and all affiliates / identities / bodies / partners, of The Muscle Help Foundation or MHF including all associated brands ie. Muscle Dreams and Muscle Warriors, all of their volunteers, officers, directors, employees and agents ("The Muscle Help Foundation") will be delivering a virtual Muscle Dream experience for:

    Muscle Dream participants, referred to herein as ‘a participant’ and/or ‘the beneficiary’:
    Parent(s)/legal guardian(s) of minor participants, and other adult participants, if any, understand that involvement in the Muscle Dream may involve risk of injury or harm to the participants and agree that this risk is fully assumed by me/us, and other adult participants, if any.

    Additionally, in consideration of the Muscle Dream experience, and if it so determines, delivering the Muscle Dream, I/we and other adult participants, if any, hereby release and agree to hold The Muscle Help Foundation harmless for, from and against any and all liability, damages and claims of any kind, known and unknown, which may be connected with, result from, or arise out of the consideration, preparation, fulfilment or participation in the Muscle Dream, as currently requested or as altered in the future.

    This includes, but is not limited to, liability, damages and claims resulting from economic loss, physical injury, illness (due to for example cold/hot weather), or death.

    Publicity / PR / Media Exposure

    Parent(s)/legal guardian(s) of minor participants, and other adult participants, if any, further understand that involvement in the Muscle Dream may result in publicity, whether or not The Muscle Help Foundation actively takes steps to publicise the Muscle Dream experience or not.

    Additionally, in consideration of the Muscle Dream experience, and if it so determines, granting the Muscle Dream, I/we and other adult participants, if any, hereby release and agree to hold The Muscle Help Foundation harmless for, from and against any and all liability, damages and claims of any kind, known and unknown, which may be connected with, result from, or arise out of the use, distribution or disclosure of any photographs, films, videotapes, electronic recordings, art work, or any other information regarding participants and the Muscle Dream, through any media, be it online or offline such as social posts whatsoever, including but not limited to the internet, electronic media, and/or any print publications.

    Disclosure Authorisation

    The beneficiary’s child's parent(s)/legal guardian(s) authorise The Muscle Help Foundation to obtain any medical information about the delivery of this virtual Muscle Dream experience which they may feel necessary for consideration or fulfilment of this event. Information obtained in this way will be kept within the charity in line with strict data protection guidelines.

    Required Signatures:

    I/we acknowledge reading, understanding, and agreeing to the conditions of this Liability Release and Disclosure Authorisation and are signing below to bind themselves, their minor children, their heirs, successors, assigns and estates.

    I/we agree that no modification of this Liability Release and Disclosure Authorisation has been made orally or in writing. (In cases of joint custody BOTH parents to sign)

    Parent/Legal Guardian of recipient

    Sign in the white space below using your cursor if on destop or your finger if on mobile/tablet devices:

    Parent/Legal Guardian of recipient

    Sign in the white space below using your cursor if on destop or your finger if on mobile/tablet devices:

    Witness Signature

    Sign in the white space below using your cursor if on destop or your finger if on mobile/tablet devices:

    Witness Signature

    Sign in the white space below using your cursor if on destop or your finger if on mobile/tablet devices:

    I/we and, if any, other adult participants, (“other participants”) acknowledge reading, understanding, and agreeing to the conditions of this Liability Release and Disclosure Authorisation and are signing below to bind themselves, their minor children, their heirs, successors, assigns and estates. Other participants further acknowledge, understand, and agree to be bound by the publicity authorisation selection of the child’s parent(s)/legal guardian(s). Other participants agree that no modification of this Liability Release and Disclosure Authorisation has been made orally or in writing.
    Other Adult Participant, if any

    Witness Signature:

    Sign in the white space below using your cursor if on destop or your finger if on mobile/tablet devices:

    Other Adult Participant, if any

    Witness Signature:

    Sign in the white space below using your cursor if on destop or your finger if on mobile/tablet devices:

    Parent/Legal Guardian of Other Minor, if any

    Witness Signature:

    Sign in the white space below using your cursor if on destop or your finger if on mobile/tablet devices:

    SECTION THREE = GDPR Contact Permission + Preferences

    In line with General Data Protection Regulation (GDPR) compliance and regulations, The Muscle Help Foundation (MHF) requires your consent to contact you about this virtual Muscle Dream event and / or any associated activities, in addition to including any future comms such as charity updates ie. news items, fundraising, campaigns or online events such as quizzes or broadcast initiatives.

    By giving MHF your consent, the charity will hold your data securely. You can opt out of our monthly e-mail updates at any time. The charity will never pass your details on to any 3rd party for their marketing purposes. We will only ever contact you through the communication channels that you have explicitly given your consent for, in line with the stated preferences below.

    YOUR SIGNATURE HERE

    Sign in the white space below using your cursor if on destop or your finger if on mobile/tablet devices:

    I consent to be contacted by The Muscle Help Foundation (MHF) about its charitable activities, by:

    Please circle either YES or NO for one or more of the different points of contact below:

    EMAIL

    TELEPHONE/SMS

    POST

    Address

    I understand that by completing and signing this form, I am giving consent to The Muscle Help Foundation (MHF) to contact me by email, phone or by post in order to stay in touch with the activities of the charity.

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