JL Kids Crew 2023 Application

Referrer Information

Relationship to Child*

Self
Parent/Guardian
Medical Professional
Family Member/Relative
Other

How did you hear about the Joey Logano Foundation?*

Social Worker
Family Member
Website
Social Media
Grant Recipient Organization
Other

First Name*

Last Name*

Phone Number*

Email*

City*

State*

Zip Code*

JL Kids Crew Applicant Information

First Name*

Last Name*

Gender*

Age*

Date of Birth*

In order to facilitate the JL Kids Crew experience, please select all that apply to the child you are referring:*

This child is non-verbal
Limited physical mobility
Vision impairment
Sensory sensitivity
Currently undergoing medical treatment
None of the above

Family Information

Parent or Guardian

Parent or Guardian First Name*

Parent or Guardian Last Name*

Parent or Guardian Address*

Parent or Guardian City*

Parent or Guardian State*

Parent or Guardian Zip Code*

Parent or Guardian Email Address*

Parent or Guardian Primary Phone Number*

Number of Siblings*

Medical Information (if applicable)

Primary Diagnosis

Approximate Diagnosis Date: Month/Year

Is there a medical reason why we need to move quickly?*

Yes
No

JL Kids Crew Program Questions

Parent or Guardian

Why do you feel this child you're referring would value participating in the JL Kids Crew program?*

You are required to submit a video within 5 days of application submission of the child and/or guardian expressing what a day with Joey Logano would mean to them.*

Yes, I will submit a video to foundation@joeylogano.com

*If video is too large to send via email, go to www.wetransfer.com and use their free service to send your file.

Share a recent photo of the child you are referring.*

Please select which of the following NASCAR Cup Series Races you and your child could easily travel to and attend in 2023.*

You may select multiple races.

Thank You For Applying!