Liv - In The Journey Foundation Application

The Liv - In The Journey Foundation is a 501(c)(3) nonprofit dedicated to supporting pediatric cancer patients and their families. Our mission encompasses three key areas: creating unforgettable memories through special trips and experiences, advancing research to find better treatments and cures, and supporting families with various needs.

Child's First Name

Child's Last Name

Child's Age

Child's Birthday

Child's Gender

Male

Female

Child's Diagnosis

Diagnosis Date

Hospital of Treatment

Status of Treatment

Name of Social Worker & Contact Information

Child's Website or Social Media Site

Any Other Relevant Health Information

Parent/Guardian's Name(s)

Sibling's Name(s)

Home Address

Phone

If you could plan a memorable family trip within the U.S., where would your top three destinations be, and what unique activities would you want to experience there?

Please provide a brief descriptIon of your child’s cancer journey.

A Photo of Your Warrior

Signature

I hereby consent and authorize that photographs taken during Liv – In The Journey Foundation events or while interacting with Liv’s Happy Cart can be used by the Liv – In The Journey Foundation in any print, or web-based publications.