Sign up to attend the Annual DC Candlelighters Holiday Celebration!
Come join us on Sunday, December 13, 2026, anytime between 3:00-5:00 at the Virginia Run Home Owners Associates Building (15355 Wetherburn Ct. in Centreville, VA). Once you've made a stop there for your gifts and visit with Santa, you will be able to head over to the Bull Run Festival of Lights for the drive-though lights (approximately 3 miles from the holiday event). Please note that your child must be in active treatment for a pediatric cancer, or no more than 12 months off treatment. Be sure to complete the form carefully to ensure your registration. Upon completion of the form, you can expect to receive a confirmation email almost immediately from Jotform that your registration was received (check spam if not received). A second email will be sent to you on December 9, 2026, from dccandlelighters@gmail.com to reconfirm your registration and will have additional details about the event. If you have any questions, please contact us at DCCandlelighters@gmail.com. Please DO NOT submit the form more than one time. Thank you and we look forward to seeing you on December 13!
Full Name of ONCOLOGY PATIENT (Name of the child who is/was in cancer treatment. NOTE: To be eligible for this event, your child must currently be in active treatment or have completed treatment in December 2025 or 2026.)
*
Child's First Name
Child's Last Name
Oncology Child's Age:
*
Oncology Child's Gender:
*
Parent/Guardian Name:
*
Parent/Guardian First Name
Parent/Guardian Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
List the clinic or hospital where your child is/was receiving treatment:
*
Please list name of clinic, hospital, or doctor's name
Date of Diagnosis
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Approximate date is fine. Doesn't have to be exact.
Date Treatment Ended if treatment has completed. (NOTE: If your child completed treatment in November 2025 or earlier, they are not eligible to attend this event.)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Approximate date in the month is fine. Doesn't have to be exact.
Name, Age & Gender of Sibling #1 Attending:
Example: Sally Age 5, Girl
Name, Age & Gender of Sibling #2 Attending:
Example: William, Age 9, Boy
Name, Age & Gender of Sibling #3 Attending:
Be sure to include NAME, AGE & GENDER
If more than 3 siblings are attending, please add their NAMES, AGES & GENDERS here:
EXAMPLE: Kyra, Age 3, Girl; John, Age 8, Boy, etc
Submit
Should be Empty: