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Home
About Sweetwater
Zayden’s Toy Drive
Zayden’s Story
Community Cup
Kai’s Warriors
Family Application
Tributes
Thank You Donors
Blog
Resources
Donate
Application For Families In Need
Fill out the form below and we will be in touch with you as soon as possible.
First Name
Last Name
Child's Birth Date
If your child was to have a party, what theme would they pick?
Date of Diagnosis
Treatment Status
In Treatment
Relapse Treatment
Remission/NED
Passed Away
Other
Where is/was your child treated?
Do you have social network sites designated for your child?
Yes
No
If yes, please provide the links
Do you have a website? (If no, leave blank)
Do you have a fundraising page for your child/family?
Yes
No
If yes, please provide the links
Is there any more information you would like to share about your child's treatment?
Legal Guardian First Name
Legal Guardian Last Name
Do you have social media?
Yes
No
If yes, please provide the links
Sibling's Name(s), Gender(s) and Birthday(s)
Anything else you'd like to share about your children?
How did you hear about SweetWater?
Mailing Address
(Please keep in mind this is where a portion of your support will be mailed.)
Email
Phone Number
Would you be interested in having your story told on SweetWater social media?
Yes
No
What skills or talents do your family members have? What is your family passionate about?
What brings your family the most comfort? What do you and your family love? Anything to avoid? (Please be as detailed as you would like to be).
What are your top 5 favorite restaurants?
List the top 5 people your child would dream to meet / talk to
List the top 5 things your child or family would love to do
Have you introduced yourself on our Facebook page?
Yes
No
Disclaimer
Your submission of this form is to help us get to know your families only and not a guarantee of assistance. If you have any questions please email us at
[email protected]
with the words "FORM SUBMISSION" in the subject line.
I have read, understood and agree with the above statement. I want to receive communications (newsletters, alerts, announcements, etc.)
Send