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  • FESTIVAL OF TREES
  • Programs
    • Hospital Programs
    • Patient and Family Assistance
    • Quality of Life Programs
  • Home
  • About
    • Values
    • Staff
    • Board of Directors
    • Contact Us
  • Camps
  • Events
    • Not-So-Muddy Grass Volleyball
    • 2022 Festival of Trees
    • Host an Event
  • Give
    • Donate
    • Volunteer
  • Newsletter
  • Search

Quality of Life New Applicants

CTHF Quality of Life Programs - New Applicant Form

The information you share is provided to the Quality of Life Coordinator in order to best assist your child. If you ever have a concern, or your child's health conditions change, please let the coordinator know.
Date of Birth
Please enter a number from 0 to 100.
Gender
For grant applications
For grant applications

MEDICAL HISTORY

Please explain what your current diagnosis is or what you know about it briefly
Please explain any pertinent history that could affect physical activity
Please explain any pertinent history that could affect physical activity
What and how often
Do you have any Range of Motion (ROM) limitations?(Required)
Can you walk independently?(Required)
Wheelchair Use(Required)
Type
Can you transfer independently?(Required)
If NO, how much assitance do you need?(Required)
Have you ever been a Carrie Tingley Hospital Patient?
Do you have any food allergies?(Required)
Snacks provided after activities
Shirt Size
XL and XXL = adult only
XL and XXL = adult only

PHOTOGRAPH CONSENT FORM

I grant permission to Carrie Tingley Hospital Foundation, a 501c3 non-profit, to use photographs/videos taken of me on the date listed below for use in publications such as brochures, newsletters, social media, television, newspaper, and magazine publications, to use the photographs on display boards, and to use such photographs in electronic versions of the same publications or on websites or other electronic form or media. I hereby waive any right to inspect or approve the finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation that arises from or related to the use of the photograph. I hereby agree to release, defend, and hold harmless Carrie Tingley Hospital Foundation, its agents or employees, including any firm publishing and/or distributing the finished product in whole or part, whether on paper or via electronic media, from and against any claims, damages or liability arising from or related to the use of the photographs, including but not limited to any misuse, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution. I understand this PHOTO/MEDIA Release may also be used by Carrie Tingley Hospital Foundation third party partners. Consent for Minor: (if under 18 years of age) I am the parent or legal guardian of the minor named above and have the legal authority to execute the above release. I approve the foregoing and waive any rights in the premises.
Parent Consent
I understand that they will not use my child’s name or my name unless I give express permission for them to do so(Required)
Date(Required)

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT WITH PARENTAL CONSENT (“AGREEMENT”)

IN CONSIDERATION of being permitted to participate in any way in any event (“Activity”) at any time during the current calendar year I, for myself, my personal representatives, assigns, heirs, and next of kin: 1. ACKNOWLEDGE, agree,and represent that I understand the nature of the Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if, at any time, I believe the conditions to be unsafe, I will immediately discontinue further participation in the Activity. 2. FULLY UNDERSTAND that: (a) THIS ACTIVITY INVOLVES RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH (“Risks”); (b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the conditions in which the Activity takes place, or THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW; (c) there may be OTHER RISKS or SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation, or that of the minor, in the Activity. 3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the sanctioning organization(s), their administrators, directors, agents, officers, members, volunteers, and employees, other participants, officials, rescue personnel, sponsors, advertisers, owners and lessees of Premises on which the Activity is conducted, (each of the forgoing shall be considered one of the RELEASEES herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED, OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if,despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may be incurred as the result of such claim. I ACKNOWLEDGE THAT I AM AGE 18 OR OLDER, HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE, AND I INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT

About Us

Carrie Tingley Hospital Foundation is a philanthropic organization providing individualized services that bridge the gap for families and children with special needs that enable them to reach their full potential by giving them the same opportunities as children who are typically developing.

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Tread Setters

 

The Tread Setters, formerly called the Zia Freewheelers, is a youth adaptive cycling program of the Carrie Tingley Hospital Foundation. Visit our Tread Setters Page here!

Keshet Dance

 

Founded in 1996, Keshet is an arts-based non-profit organization which exists to inspire and unite the community by fostering unlimited possibilities through dance, mentorship, and creative space for the arts. Keshet has different opportunities for CTHF kids to join, register and learn more today by visiting their website at keshetarts.org or by emailing sadie@keshetarts.org!

Adaptive Sports NM

 

Since 1985, the Adaptive Sports Program New Mexico has offered therapeutic recreational activities to children and adults with disabilities. Today, ASPNM proudly offers a wide variety of adaptive sports year-round, including skiing, snowboarding, watersports, river rafting, yoga, rock climbing, and more.

Programs are open to children and adults with disabilities at locations throughout New Mexico. Some programs are open to family members and caregivers. Veteran-specific programs are offered periodically throughout the year. If you are interested in getting involved as an athlete, volunteer, or supporter, please contact us for more information. Learn more here.

New Mexico Blade Runners Adaptive Sled Hockey

Learn to skate and enjoy the freedom of flying across the ice! The sled hockey team integrates players of all abilities and ages. Players unable to propel their sleds on their own will have a volunteer to push their sled from behind. Participation is free. Practice is held at the Outpost Ice Arena 9530 Tramway Blvd NE, Albuquerque, NM 87122.

Register

CTHF Wheel Runners – Wheelchair Basketball Team

Become a part of our awesome wheelchair basketball team! Any child between the ages of 6 – 18 years of age with physical disabilities are invited to participate. Participation is free. Practice times are on Saturday’s from 10 – 11:30 a.m. at the JCC Albuquerque at 5520 Wyoming Boulevard NE, Albuquerque, NM 87109.

Register

Zia Freewheelers Adaptive Cycling Team

Join our incredible adaptive cycling team! CTHF takes the care and time to match each child with a bike that best suits their needs. Ride off on Albuquerque’s beautiful trails with friends and family. Everyone is welcome, bring your own bike, or borrow one of ours. Participation is free. Our spring rides start at the Alameda Open Space, dates and times are as follows:
Saturday, April 4 at 1pm we will have a kickoff event. More details to follow but get it on your calendar!
Sunday, April 19 at 1 pm
Sunday April 26 at 1 pm
Sunday May 3 at 1 pm
Sunday May 10 Mother Day! No ride.
Sunday May 17 at 1 pm. Final Ride of Spring Season.

Register

Camp Adventure

Carrie Tingley Hospital Foundation is proud to support our kiddos and our communities by holding three summer camps and multiple mobile camps throughout the year in various parts of the state. Please visit our camps page here to learn more!

Adaptive Kayaking

CTHF partners with Kayak New Mexico to offer adaptive kayaking to the children of Carrie Tingley Hospital. Have fun gliding across the water while exploring a new activity. Kayak New Mexico takes care to move past physical disabilities and teach skills that will help your child on and off the water. Located at the Rio Rancho Aquatic Center, 745 Loma Colorado Dr NE, Rio Rancho, NM 87124. For more information or to register, visit their website http://www.kayaknewmexico.org/ or call 505-980-7207. A nominal fee is required.

Adaptive Horseback Riding

CTHF partners with three wonderful therapeutic horseback riding programs. Each organization is dedicated to CTHF children and their overall health, safety and happiness. Please visit each site for more information. Please contact the organization you are interested in first for an evaluation. Sholarships are available.
Cloud Dancers Therapeutic Horsemanship
Enchanted Equine Adventures, LLC
Loving Thunder Therapeutic Riding, Inc

Adaptive Swim Lessons

CTHF partners with the JCC Albuquerque to offer adaptive lessons that are modified for children with physical disabilities. The therapy pool is 15 yards long and 1 – 4 ft deep. A handicap ramp is available for those needing assistance. Lessons are located at 5520 Wyoming Boulevard NE, Albuquerque, NM 87109. For more information or to register, visit their website https://jccabq.org/. Scholarships are available.

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