Refer a Warrior — Nathaniel's Childhood Cancer Foundation

Request a Warrior Pack

Do you know a child we could help? Provide your email address and name and we will email you our referral form.

Guardian's Name

First Name

Last Name

Guardian's Email

Guardian's Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian's Contact Phone Number

(###)

###

####

Warrior's Name

First Name

Last Name

Warrior's Age

Warrior's Gender

Boy

Girl

Warrior's Diagnosis

Warrior's Likes

Warrior's Dislikes

Any Sensitivities

(noise, lights, songs etc.)

If your Warrior has any siblings under the age of 18 please list their names, ages and gender

(Warrior Pack's include items for the Warrior's siblings)

Photo Release Form

I hereby authorize Nathaniel’s Childhood Cancer Foundation Inc., to publish the photographs, or videos taken of me and/or my children, along with our names if desired, for use in printed publications, videos and on authorized web sites. I acknowledge that, since my participation in media produced by these entities is voluntary, I will receive no financial compensation. I further agree that my participation in any media produced by these entities confers upon me no rights of ownership whatsoever. I release these entities and their officers, directors, managers, members, partners, agents, volunteers, employees and board members from liability for any claims by me or any third party in connection with my participation.

Authorize

Do not Authorize

Inclusion of Christian Based Material

Nathaniel’s Childhood Cancer Foundation is a Christian based organization. Each Warrior and/or Protector pack will include Christian based material which includes an age-appropriate Bible. Due to Nathaniel’s Childhood Cancer Foundation’s strong Christian values, the inclusion of the Christian based material is not an option that can be opted out of. By submitting this request form, you, hereby authorize Nathaniel’s Childhood Cancer Foundation Inc. to include Christian based material in your child’s/children’s warrior and/or protector packs.”

Authorize