2018 DSAH Calendar Model Application
Our mission at DSAH is to provide programs and support to individuals with Down syndrome, their families, and the professionals who serve them, and to create awareness in the community through advocacy, education and medical outreach.

We envision a community in which all people with Down syndrome have the opportunity to enhance the quality of their life, realize their life aspirations, and become accepted as part of our very diverse society.

The Down Syndrome Association of Houston (DSAH) is looking for members with Down syndrome to pose for the annual Celebrating Love & Hope Calendar. Filling out this application does not secure your child a position in the calendar. It only means they will be considered.

Decisions regarding calendar spots are at the discretion of the Calendar Committee. We aim to reflect the diversity of our membership. All calendar images may be used in a variety of media (print, TV, ads, website, etc.). If you object to signing over rights in ALL areas please DO NOT fill out this application.

APPLICATIONS MAY BE E-MAILED OR COMPLETED ON LINE.

After completion of this application please make sure to e-mail a photo of your child to calendars@dsah.org


Email address *
Applicant’s Name *
Your answer
Age & Date of Birth *
Your answer
School District (if applicable) *
Your answer
Gender *
Ethnicity/Race *
Your answer
Has the Applicant been featured in the DSAH Calendar before? If yes, what year? *Members who have never been featured will take priority. *
Your answer
Is this your first year applying? If not, number of years applying? *
Your answer
Parent/Guardian Name *
Your answer
Address, City & State, Zip Code *
Your answer
Phone number (cell) *
Your answer
Phone number (work/home) *
Your answer
Applicant Qualifications- Child/Adult with Down syndrome *
Required
The family is up to date on their DSAH membership (2017) *
Submit recent image of child via email (calendars@dsah.org) or attached to paper copy of application. Photo will NOT be returned or used in calendar. *
Required
Family has a Buddy Walk Team (unless new). Answer Yes or No. If yes, tell us the name of your team *
Your answer
Application & photo must be submitted by April 15th, 2017 to be considered. No exceptions. *
Required
If chosen, the family commits to the photo shoot at an agreed time and each model is responsible for their own transportation. *
Required
Can the applicant sit and stand independently? *
Required
Can the applicant tolerate unfamiliar surroundings and/or people? *
Required
List the DSAH activities or disability advocacy in which you have been involved (i.e. Gymboree at the Resource Center, community groups, committees, Buddy Walk, Buddy Run, Buddy Bowling/Basketball, Panther Pack, etc.) *
Your answer
In 30-100 words “tell me about you” (self-advocate or parent about child). Ex: favorite book, toy, computer game, things your child likes to do with family, etc. *
Your answer
I understand that if the above named applicant is selected to serve as a 2018 DSAH Calendar Model, my family is responsible for upholding the mission and vision of the Down Syndrome Association of Houston *
Required
Representing the Down Syndrome Association of Houston at various activities and events throughout the year, including fundraising initiatives *
Required
Captain a Buddy Walk® team, raising no less than $1,000 in the fall *
Required
Selling no less than 50 calendars totaling $600 *
Required
Providing DSAH with my credit card number. If calendars are not picked up, sold, or returned, my credit card will be charged for the full amount or the amount not sold. *
Required
Providing content for DSAH newsletter, website, & other social media outlets upon request *
Required
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms