Care Package Application

If your loved one is battling childhood cancer and you’d like to apply to have a customized Care Package shipped to you, please complete this application.

Please note that items for siblings will be included whenever funding allows. Once applications are processed and validated, Care Packages are shipped in order in which applications are received.

Child's first and last name

First Name

Last Name

Child's Age

Child's diagnosis

Child's gender

Child's interests

The more you provide, the more customized your child's package will be!

Child's Clothing Size

URL of support/update pages for the child:

If available - typical ones include GoFundMe, Facebook groups, Instagram accounts

When is your child estimated to finish treatment?

This may allow me to recommend additional resources that you may benefit from.

Social Worker Info

Hospital Child is Being Treated At

Do you give Strong Little Souls permission to speak with your child's social worker?

Yes

Social Worker's Name

First Name

Last Name

Social Worker's Phone

(###)

###

####

Social Worker's Email

Sibling Info

Does the child have siblings?

Please list sibling age(s) and interests:

Parent/Guardian Info

Parent/Guardian name

First Name

Last Name

Parent/Guardian email

Parent/Guardian phone

(###)

###

####

Permanent mailing address for the package:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Other Information/notes/concerns:

Care Package Application

Strong Little Souls © 2022
501(c)(3)

TAX ID: 84-4692020

Care Package Application

Strong Little Souls © 2022501(c)(3)

TAX ID: 84-4692020

Strong Little Souls © 2022
501(c)(3)