Hope Tote Request Form

Whether you are a cancer parent or know a family being treated for childhood cancer, please fill out this form and we will send the family a hope tote.

Cancer Parent Hope Tote Request

This is for cancer parents to request a Hope Tote and friends who would like to send a Hope Tote to a family recently diagnosed with childhood cancer. Please consider making a donation to help us continue to sending out our Hope Totes!

1. Your Name*
2. Your Email*
3. Recipient's Name (Required)*
4. Recipient's Age (Required)*
5. Recipient's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please add the address of the family or the person receiving the bag on behalf of the family. No P.O. Box please.
6. Type of Childhood Cancer*
7. Name of Childhood Cancer*

This information is only used to decide which of the 3 different cancer books are needed in the Hope Tote. (Solid Tumors, Brain and Spinal Cord Tumors, or Leukemias)
8. Would you like us to include your name as the sponsor of the Hope Tote?
9. Additional Comments
10. How did you hear about Team G's Hope Totes?*

Cancer Parent Hope Tote Request

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