Partner Registration Form 2024-2025 0% Complete1 of 5 Acknowledgements - Partner Registration Welcome to the Buckle Up for Life Partner Registration Form. Before we proceed further, please review and affirm each statement below--just to make sure we are on the same page. Failure to check every box may result in disqualification of your registration. I acknowledge and understand each of the following statements (please check all to proceed): * This Buckle Up for Life partner registration is free, and non-competitive. While there is no deadline to complete Buckle Up for Life's partner registration (which may be submitted on a rolling basis anytime through the year), subsequent partnership opportunties (E.g., Gift of Safety, Community Grant, etc.) do have specific application periods, with firm deadlines, as posted on https://www.buckleupforlife.org/our-partners/become-a-partner. This Buckle Up for Life partner registration will, by default, provide my organization limited partner benefits, for the 2024-2025 program year, as described at https://www.buckleupforlife.org/our-partners/become-a-partner/. Completion of this registratration is a prerequisite to applying for additional partnerships (E.g., Gift of Safety, Community Grant, etc.). For more information about Buckle Up for Life partnership opportunities, I can visit https://www.buckleupforlife.org/our-partners/become-a-partner. Buckle Up for Life partner registration must be completed/renewed each program year in order to maintain associated benefits. My organization should only submit one partner registration per program year. If I need to retract or edit my registration, due to error, technical issue, or other reason, I will contact buckleupforlife@cchmc.org for assistance. In any case where the same tax ID/EIN is listed on more than one registration, all such registrations may be canceled. While I may have optional opportunities to report on my work and/or to share my successes with Buckle Up for Life, I will not be required to participate in any activities, nor to meet any deliverables nor to formally report outputs/outcomes to Buckle Up for Life, based on this partner registration alone. Note, that additional partnerships (E.g., Gift of Safety, Community Grant, etc.), if awarded, do require specific deliverables to be met and reporting to be completed. I will not share any Protected Health Information (PHI) regarding families or individuals I serve through my program with Buckle Up for LIfe. No identifying information should be provded, unless specifically requested, and unless the appropriate consent/releases have been voluntarily completed and provided by relevant parties. I will comply with Buckle Up for Life's Curriculum and Brand Use Agreement. My free partner benefits depend on availability of prime award funding from our sponsor, as well as other factors, and may change at any time, with or without notice. If you are human, leave this field blank. Next
