Warrior (Age 6yrs - 12yrs) Sign Up Form
Thank you for your interest in signing up your Warrior child with Cancer
Warriors, Inc.  

Every new “Warrior” receives a “Warrior Angel” and “Christmas Angel" while
receiving chemotherapy and/or radiation treatment for cancer.  The “Warrior”
child is considered a part of the Cancer Warriors family until he/she is
considered "off treatment" or receives a transplant.  

PLEASE NOTE: Christmas Angels are only assigned upon having enough
volunteers so we cannot guarantee this will be possible but certainly do our
best to make this happen every single year.  

We are excited to have you as a part of our growing family and pray your time
with us will be a positive experience. We need as much information as
possible to be able to assign your child the best possible Warrior Angel.  
Please remember it is the responsibility of the parent/guardian to let us know
if the child has any changes in treatment.

If your child does NOT have a website that is updated regularly, then please
email a photo of your child to us.  Our Angels like to "see" who they are
sponsoring and a photo will be fine if you are unable to maintain a website.  
Just email the photo of your choice to angelnetwork@cancerwarriors.org

Please answer the following questions:   
Patient's Name:
Patient's Street Address:
City, State:
Zip Code:
Patient's Birthdate:
Patient's Diagnosis:
Date of Original Diagnosis:
Estimated Off Treatment Date:
* (An estimated date MUST be included or child is automatically denied)
Oncologist's First & Last Name:
Oncologist's Address & Phone:
Please Let Us Know If Child
Has Any Handicaps, Allergies:
Parent/Guardian's Name:
Parent/Guardian's Phone:
Parent/Guardian's Email:
Note:  Email is our main form of communication.  Applications submitted without
a valid email address will be automatically denied.
TELL US ABOUT THE CHILD WARRIOR
Shirt Size:
Shoe Size:
Child's Favorite Type Toys:
Child's Favorite
Snacks/Foods/Restaurants:
Child's Favorite Cartoon
Characters/Super Heroes/
TV Shows:
Does Child Have A VCR?
Yes, we have a VCR
No, We don't have a VCR
Does Child Have A DVD?
Yes, We have a DVD
No, We don't have a DVD
Child's Website Address:
Please list any special places or activities your family enjoys doing together
when child is not hospitalized?
Please list child's favorite sports, hobbies, etc., or anything else your child enjoys that has
not been listed, or anything else you'd like us to know about your child:
Warrior Child's Family
Sibling #1:  List Name, Age, Favorite Hobbies, Foods, Activities, Shows,
Characters, TV Personalities, Sports, etc:
Sibling #2:  List Name, Age, Favorite Hobbies, Foods, Activities, Shows,
Characters, TV Personalities, Sports, etc:
Sibling #3:  List Name, Age, Favorite Hobbies, Foods, Activities, Shows,
Characters, TV Personalities, Sports, etc:
Please tell us how you heard about us!
Please check this box only if you wish for us to use your child's picture (you must have
provided a website or email a picture for us to use). Only FIRST NAME will be used in our
upcoming awareness video or any other awareness material we may produce.  (Leave
blank if you do not wish your child's picture to be used).  You must email us a picture if
your child does not have a website listed on this form.
By submitting this form, you are requesting your child to be a part of Cancer Warriors and
agree that all the personal information you have provided for the child is true and correct.  Any
false information provided will be punishable at the highest extent of the law.  We have the
right to verify all information provided and exercise this right.  You will receive a form to have
signed by your child's oncologist before being accepted into our Organization.  It will be
mailed immediately to the address you provided for the child.  Thank you for allowing your
child to be a part of our Organization.  Either party can cancel participation at any time for any
reason.
Parent/Guardian Signature:
Note: Cancer Warriors considers a typed name a valid signature.
TODAY'S DATE:
"Because Kids Get Cancer Too!"
Cancer Warriors, Inc.
Help For Children Battling Cancer