DREAMS for DANNY: Other parent/legal guardian statement Question Title * 1. Information Your Name Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number OK Question Title * 2. Child's Name OK Question Title * 3. I hereby confirm that I am jointly submitting the application for the Dreams for Danny: Surgical Evaluation Travel Scholarship. Yes No OK Question Title * 4. Name of other parent/guardian who submitted the application: OK DONE