Derby Day Benefit 2026 was an elegant soiree!

The Derby Day Benefit was Stir-n-Up Hope’s 5th Annual Spring Fundraiser… and the community broke records for fundraising for the mission!

FILL OUT THE PRELIMINARY APPLICATION BELOW

Prospective Participant Name

DOB

Height

Weight

Street Address

City, State, Zip Code

Doctor Name

Doctor Phone Number

Behavior Concerns (i.e. elopement, aggression)

Please describe mobility level/needs. Do they require support while sitting?

Health Concerns/Diagnoses (i.e. hemophilia, seizures, Down Syndrome, implanted devices)

Is Axial Skeleton closed? (for Down Syndrome only)

Date of Last Seizure (if applicable)

Contact Name

Contact Phone

Contact Email

Relationship to Participant

In Case of Emergency Call

How did you hear about us?

What outcomes are you hoping will result from time at Stir-n-Up Hope?