Patient Application

We're here for you

Eligibility Requirements:

Programs are for critically ill children under the age of 18.  Children must meet at least 2 of these 4 requirements:
1.       Child is diagnosed with a critical, life-threatening illness
2.       Child is frequently hospitalized
3.       Child is receiving active treatment
4.       Child is on hospice care

The child's primary physician and social worker should complete applications. When more than one diagnosis is involved, each attending physician must complete a medical statement.

Eligibility will be determined by the Foundation after physician's assessment. Applications will be reviewed and approved by the Program Director. Applications for critically ill children will be updated and reviewed every two years. Siblings may participate in programs until age 21. Patients will remain eligible for one year after last active treatment (Routine follow-ups excluded). Families are encouraged to participate in programs through the Better Together Program for one year after the loss of the child participating in programs. 

Click here to download our application

Testimonials

We had a fantastic time at the game! Being on the field for the pre-game warmup was an incredible experience that we'll always remember. Jimmy was so excited to attend his first NFL game. You certainly gave him a lot to smile about! He starts his next round of chemotherapy tomorrow. The memories of being at the game will help sustain him through the treatment, and give him stories to share with his doctors and nurses.

The Alverson Family

Thank you so much for the movie gift cards! Ben’s dad takes him and his brothers to a movie every year on Christmas Eve. This year we are so happy that Ben has finished his chemo and is feeling well enough to keep up their tradition. The cards will be used to buy tickets to see Star Wars and get some special treats at the concession stand.

The Nussbaumer Family