General Application

This application is for families of children with disabilities who are looking to become a Variety Family, and do not need financial assistance with durable medical equipment or therapy services at this time.

As a Variety Family, you will be added to our exclusive email list and will be invited to free events as well as be notified when registrations for our enrichment programs, including Adventure Camp, Variety Theatre, Variety Children’s Chorus, and Variety Dance, open.

If you do need financial assistance with durable medical equipment or therapy services for your child with a disability, please fill out this application instead.

Child’s Information

Name(Required)

Birthday(Required)

Gender(Required)

Primary Diagnosis(Required)

Additional Diagnoses

Parent Information

Primary Guardian(s)(Required)

Relationship to Child(Required)

Primary(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

*Your response to the following question is optional and will not affect the status of your application. The information requested is useful to St. Louis Variety in grant applications and other activities seeking additional funding for our assistance programs.

What is your child’s race/ethnicity

School Child Attends

School District Child Attends

How did you hear about Variety

General Application