B Happy Questionnaire

All forms must be completed and sent to Aisling: Aisling@BtheDifference.org

Step 1: Download and fill out the General Release Form here. Complete for every individual on the trip. A legal guardian will have to fill out and sign on behalf of a minor (under the age of 18).

Step 2: Download and fill out the Medical Release form here. Complete for every participant with NF (or with significant medical conditions) and have their doctor sign off.

Step 3: Complete and submit the form below. Please note we cannot book anything without the completion of all the above forms.

"*" indicates required fields

Step 1 of 3

Please Tell Us About Yourself

Recipient Name*

First Last

Recipient Birthdate*

Recipient Gender

As listed on your photo ID

Recipient Cell Phone

If minor, provide guardian cell phone.

Recipient Email*

If minor, provide guardian's email address.

Recipient Address*

Please provide a valid shipping address.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Confirm Recipient Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have NF1, NF2, or Schwannomatosis?*

At what age were you diagnosed with NF?*

Will you require a wheelchair/will you be bringing your own wheelchair?*

Do you have any physical limitiations?*

Please be as specific as possible to help us properly plan.

Do any of your family members also have NF? If so, who?*

Additional Family Members Accompanying You On Your Trip

From experience, we know that NF not only affects the person afflicted but the other family members who make multiple sacrifices. Having said that, of the immediate family members living with you, who will be accompanying you on your B Happy trip? Trips are limited to a total of five people including the recipient.

Name

First Last

Relationship

Gender

As listed on your photo ID

Birthdate

Cell Phone

Add Family Member

Name

First Last

Relationship

Birthdate

Cell Phone

Add Family Member

Name

First Last

Relationship

Birthdate

Cell Phone

Add Family Member

Name

First Last

Relationship

Birthdate

Cell Phone

B the Difference Merchandise

We will provide you with B the Difference branded hats and water bottles to use on your B Happy trip and beyond. These will be shipped to the mailing address you provided above.

The B hats (see here) come in two color combinations: black with a white logo, and white with a full color logo. Please let us know which option each family member would like, and we will send them to you prior to your trip.

B Hat Choices*

Upload Family/Individual Photo

Please upload a family photo that we will share with your host.

File*

Max. file size: 15 MB.

Please Tell Us About Yourself

Trip Details

Medical Details

Additional Family Members Accompanying You On Your Trip

B the Difference Merchandise

Upload Family/Individual Photo