Application for Family Support

Application for Family Support

Please complete this form to apply for financial assistance for your child's treatment. Eligibility requirements: child must have a cancer diagnosis. Child must be 21 years or younger. Child must live or receive treatment in New England (MA, CT, RI). Application cannot be processed without a valid pediatric oncology social worker contact information. For application questions, please contact us: fightlikeakidfoundation@gmail.com
GAME DAY INFORMATION:

Every Fight Like a Kid game is about reminding families that no child fights alone. If selected, your child and family will be the heart of one of our community games, where players, fans, and supporters come together to raise awareness and funds in your honor. Proceeds from the event will directly benefit your family. We hope you'll be able to join us and experience the incredible support firsthand, but understand if attending isn't possible. Whether you're in the stands or cheering from home, your family will be celebrated and surrounded by a community that is fighting alongside you. Please let us know your child's favorite sport and we will try to accommodate that sport.
Child's Information
Child's Full Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Child's Gender
Cancer Diagnosis
Date of Cancer Diagnosis

MonthDayYear
Date
Does your child fighting cancer have siblings?
If you feel comfortable list names and ages- we want to support the whole family.
Child and siblings favorite sport(s)?
Family Information
Parent/Guardian Full Name

First NameLast Name
Primary Email Address
example@example.com
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Primary Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Primary Address and Mailing Address
Patient Information
Please Confirm Treatment Status:
Pediatric Oncology Hospital
Please list hospital name and city
Pediatric Oncology Social Worker
Please list their name
Social Workers Number
Please enter a valid phone number.Format: (000) 000-0000.
Social Workers Email
example@example.com
How Did You Hear About Fight Like a Kid-Team Ava? (check all that apply)

Other
Individual Submitting This Form

Please complete if different than guardian/parent above. Example: if you are filling this application out on behalf of a family affected by pediatric cancer.
Name

First NameLast Name
Primary Email
example@example.com
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to the Child
Signature
Should be Empty:

Application for Family Support

GAME DAY INFORMATION:

Child's Information

Family Information

Patient Information

Individual Submitting This Form