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 Name
*
First Name
Last Name
Child's Mailing Address (complete shipping address below if this is a P.O. Box)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child's Shipping Address (complete ONLY if mailing address is a P.O. Box)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child's Birthday
*
-
Month
-
Day
Year
Date
Child's Gender
*
Male
Female
If 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 Candy
Favorite Girl Scout Cookies
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 Day
Easter
Halloween
Christmas
Mom's First AND Last Name
Dad's First AND Last Name
Child's siblings (under the age of 15), please list age and gender
Please check each site that you utilize.
Caringbridge
Cole's Pages
Facebook
Personal Webpage
Other
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.
*
Yes
No
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.
*
Yes
No
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 Code
Phone Number
Submit Form
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