New Enrollment Form

Project Angel Hugs: New Enrollment

Please fill in the form below to enroll your child. Project Angel Hugs ministers to the emotional needs of children touched by cancer, and their families.
Child's Mailing Address (complete shipping address below if this is a P.O. Box)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's Shipping Address (complete ONLY if mailing address is a P.O. Box)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's Name*

First NameLast Name
Child's Birthday*

MonthDayYear
Date
Child's Gender*

MaleFemaleIf female, please check if ears are pierced
Likes/Dislikes*
Please be specific and provide multiple options. Include hobbies (i.e. painting, make-up, hair/nail care items, knitting, collections, puzzles, reading, board games), specific brands (i.e. Disney, Minecraft, Pokemon, Barbie, Hello Kitty, Paw Patrol), and other details (i.e. WWE, hunting, glitter & sparkles, cars, jewelry, etc.). If your child enjoys reading, please be descriptive in the type of books your child enjoys. **WE DO NOT OFFER GAMES FOR GAMING CONSOLES/SYSTEMS OR GIFT CARDS.
Favorite Color(s)
Favorite Girl Scout Cookies
Favorite Candy
Favorite Sport or Sports' Team
Favorite Animal(s)
Favorite TV Show(s)
Favorite Music Genre
Please check ALL holidays your child wants to receive boxes for.*

Valentine's DayEasterHalloweenChristmasSummerBirthday
Dad's First AND Last Name
Mom's First AND Last Name
Child's siblings (under the age of 18 in home), please list age and gender
Please check each site that you utilize.

CaringbridgeCole's PagesFacebookPersonal WebpageOther
Please list sites checked above so we can stay updated on your child's journey.
Parent/Guardian E-mail*
Do we have permission to use your child's photo in our office? Only your child's first name and last initial will be used.*

YesNo
Do we have permission to use your child's photo on our website and/or in our social media (Facebook, etc.) accounts? Again, only first names and last initials will be used.*

YesNo
Child's Diagnosis*
What hospital/healthcare facility is providing your child's treatment?
My child is currently:*

Warrior in treatment (still undergoing treatment for their illness)Graduate of treatment (completed protocol)
How did you hear about Project Angel Hugs?
Phone Number

Area CodePhone Number
Should be Empty:

Project Angel Hugs: New Enrollment