Child Updates

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Send an Update

LightWell Foundation appreciates regular updates on your child so we may better support you. While we love the personal connections, we understand that sometimes a quick web form is the best way to send in an update.

Note: If your minor child has received a cancer diagnosis, or you are submitting a request on behalf of a child’s family, and you have not connected with us yet, please send an email to [email protected] at your earliest convenience

* Indicates required field

Child's Name *

Child's Age *

Is your child currently
receiving treatment? *

Yes No

If yes, are you living at home or residing near the children's hospital? *

At home Residing near the hospital

If residing near the hospital, in what city is your child receiving treatment? *

If living at home, how often and where are you traveling for treatment and care? *

If not receiving treatment, how often and where are you traveling for scans and checkups? *

Is your child receiving care for late effects from treatment? *

Yes No

If yes, please briefly describe. *

Please provide a brief description of how things are going, what the anticipated next steps are, and anything else you'd like us to know. *

Would you like us to connect you with another local childhood cancer family? *

Yes No

Please let us know if you have a new page (CaringBridge, Facebook page, blog, email list, etc.) where we may follow along for updates. *

Would you like to continue receiving financial assistance from LightWell Foundation, if available? *

Yes No

This update was completed by:

Name *

Relationship *

Phone Number *

Email *

Family's Current Mailing Address: *

Line 1, City, State, Zip Code

*

I agree to share this information with the LightWell Foundation Board of Directors who have signed a confidentiality agreement. The information submitted is true and accurate to the best of my knowledge.

Thank you for taking the time to send in this update! We hope to be a LightWell for you on this journey.
With hope, The LightWell Foundation Board

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