Request a Cooper's Comfort Cooler
Fighters Name
*
First Name
Last Name
Fighters Birthday
*
Mom's Name
*
First Name
Last Name
Dad's Name
First Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Diagnosis
*
type of cancer
Do you have a juicer?
*
Yes
No
What Hospital is your child being treated at?
*
Social Workers Name?
*
Social Workers Phone Number:
*
Favorite Character
*
Favorite Celebrity if a Teen
If you Fighter had $100 to buy anything, what would they buy?
*
Tell us about your fighter?
*
Income Level:
*
0-$20K
$21k-$40k
$41k-$70k
$71k and up
Letter of Verification from Social Worker/Doctor
*
Browse Files
Cancel
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Please upload a photo of your fighter
*
Browse Files
All photos uploaded are used for marketing and donor engagement by Ayden's Army of Angels. Uploading your photo gives AAOA permission to use your child's photo for marketing, fundraising, marketing material, and social media platforms.
Cancel
of
By signing this application for a Cooper's Comfort Cooler, I am allowing AAOA to use my story and my childs photo to bring awareness, and support for Pediatric Cancer Families. Please allow 2 weeks to receive your Cooler after verification of treatment from your social worker. Any incomplete applications will be immediately denied IE: uploading incorrect documentation to complete application, all requested documents must be provided.
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