Care Package Application
We can’t wait to send a special package to your warrior! Please complete the form to the best of your ability.
Child's Name
*
First Name
Last Name
Child's Age
*
Child's Gender
*
Please Select
Male
Female
N/A
Child's Diagnosis
*
Estimated End of Treatment
*
Child's Interest & Hobbies (Each package is individually tailored to the child. Please describe your child's interest & hobbies to the best of your ability, the more detail the better!)
Child's Clothing Size
*
Hospital Child is Treated at
*
Social Worker's Name
*
First Name
Last Name
Social Worker's E-mail
*
example@example.com
Social Worker's Phone Number
Do you give Strong Little Souls permission to contact your social worker?
*
Yes
No
Parent/Legal Guardian Name
*
First Name
Last Name
Parent's E-mail
*
example@example.com
Parent's Phone Number
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please upload documentation confirming your child's diagnosis.
*
Browse Files
Drag and drop files here
Choose a file
Accepted forms include any document that clearly shows your child’s name, date of birth or age, and diagnosis. This can be a letter from a doctor or social worker, a MyChart screenshot, or hospital discharge paperwork. By providing this documentation, we're able to speed up the application process and offer support more efficiently.
Cancel
of
Feel free to share any links to support pages or social media accounts where you post updates about your child — we love following along and staying connected!
Please let us know if you have any additional information, notes, or concerns.
Submit
Should be Empty: