Wes' Wish Family Shopping Registration Form 2024

Family Shopping Registration Form

Hosted by The Wes Strong Foundation
Event Information

The Wes Strong Foundation is holding our 14th Annual Wes' Wish Family Shopping Expo in which families can "shop on us" for their children while facing the devastating burdens that come with diagnosis. We allow families at all phases of the journey to join us (fighting, surviving or bereaved).
***FOR IMMEDIATE FAMILIES (PARENTS/GUARDIAN, SIBLINGS) OF CHILDREN WHO ARE/WERE TREATED AT CHKD'S CANCER & BLOOD DISORDER CLINIC AS WELL AS FAMILIES OF PEDIATRIC CANCER PATIENTS IN THE SURROUNDING AREA ONLY. PLEASE NOTE: DUE TO PAST ISSUES, WE NOW REQUIRE LETTERS TO BE SENT DIRECTLY FROM SOCIAL WORKERS. ADDITIONALLY, ALL NEW FAMILIES WITH MORE THAN 3 CHILDREN WILL BE ASKED TO BRING IN BIRTH CERTIFICATES.***
***PRE-REGISTRATION AND LETTER FROM SOCIAL WORKER/PROOF OF DIAGNOSIS OR TREATMENT AT THE CHKD CANCER & BLOOD DISORDER CLINIC OR OTHER FACILITY WILL BE REQUIRED*** PLEASE EMAIL DOCUMENT TO SUPPORT@WESSTRONG.ORG
HELD ON SATURDAY, DECEMBER 14TH AT THE AVIATION INSTITUTE OF MAINTENANCE, 2329 E. LITTLE CREEK RD, NORFOLK, VA.
Your Name*

PrefixFirst NameLast Name
Email Address*
example@example.com
Contact Number*
Please enter a valid phone number.
Relationship to Patient*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Patient's Name*

First NameLast Name
Age by December 14, 2024 (if passed, age at passing):*
Gender*
Diagnosis*
Treatment Status of Patient*
Treatment Hospital*
Social Worker (if bereaved, type unknown)*

First NameLast Name
Participating siblings 18 and under
Wishlist suggestions: Feel free to list ideas of gifts your children are interested in here. (This does not guarantee their availability, but gives us an idea on what to suggest for ideas to donors)
First Choice (Time Slot) - If time slot is full, please select different time.*
Slots are available on first come, first serve basis
Second Choice (Time Slot) - If time slot says full, please select a different time.*
Please note: You can arrive at any time within the time slot you are designated.
Should be Empty:

Family Shopping Registration Form

Event Information

HELD ON SATURDAY, DECEMBER 14TH AT THE AVIATION INSTITUTE OF MAINTENANCE, 2329 E. LITTLE CREEK RD, NORFOLK, VA.