Submit a Special Event Proposal

Contact Information

What category best identifies you?

Organization or Company Name (if applicable):

Website and social media profiles:

Primary Contact Full Name:

Primary Contact Title or Role within Organization:

Email address:

Phone Number:

Have you hosted a Special Event at Nicklaus Children's before?

Yes No

Event Proposal

Preferred Event Dates:

Please provide at least 2 dates.

Preferred Event Time:

10:30 AM - 12:00 PM 1:30 PM - 3:00 PM 4:30 PM - 6:00 PM

Tell us about your proposed event in as much detail as possible:

What are the goals of your event? How will your event benefit patients and families?:

Estimated Gift In-Kind Value

Describe proposed decorations, if any. Please provide as much detail as possible, including measurements, photos, or links to previous set-ups:

Upload photo of decorations

Select a file

Describe proposed giveaway items, if any. Please provide as much detail as possible:

Describe proposed food and drink items. Please provide as much detail as possible: description, ingredients, vendor details, or links:

Would you like to receive approved photos and videos captured by hospital staff?

Yes No

What is the intended use for the media captured during the event?:

Press Releases, TV and Media requests must be approved and coordinated by our Marketing department. Will your event require PR?

Security Clearance Acknowledgement

By checking this checkbox, I acknowledge that all guests are required to obtain clearance from hospital security prior to the event by providing name and date of birth as it appears on government issued ID, such as driver's license.

Number of people in your group

Special Event Guests roles and responsibilities:

Is there anything else we should know about your event or group?:

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