Request a Pillowcase/Care Package

Our Prayer Pillowcases and care packages are intended to go to children battling cancer and their siblings. Please complete the form below to request a pillowcase and/or care package on behalf of child impacted by childhood cancer. Requests must be submitted by the child’s parent or legal guardian.

Child's name (first and last)*

Type of Cancer*

PillowcaseCare PackageBoth

Male/Female*

MaleFemale

Age or Date of Birth*

Child's likes (i.e. favorite colors, characters, etc.)*

Child's Facebook or Caring Bridge page*

Are there any siblings? If yes, please include their name(s), age(s), gender(s) and likes.

Permission to share photos?*
We LOVE to see pictures of the kids with their gifts and share with our supporters. By entering Yes you agree to allow us to share any pictures that you send to us on our Facebook, Instagram and website.
YesNo

Your Name (first and last)*

Your Email*

Address to send package.*

In Care of*

Mailing Address*

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Fighting Childhood Cancer Until There's a Cure!