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Join Candlelighters

 

Welcome, new Candlelighters families.

We understand that when a child is diagnosed with cancer, it affects each member of your family differently. Candlelighters programs and services are here for your whole family throughout this journey of childhood cancer, from diagnosis through treatment and beyond.

When you join Candlelighters, there will always be a place for you in our community of hope.

To join Candlelighters, please fill out the form below in its entirety. If you have any questions regarding this form or process, please reach out to your social worker or contact Candlelighters.

Join Candlelighters

Family Information

Candlelighters programs and services are free of charge to children and teens age 0–21 who have experienced cancer, and to their immediate family members.
Parent / Guardian 1 Name(Required)
Parent / Guardian 2 Name
If first name is entered, last name is required.
Street Address(Required)
Mailing Address (if different)

Served Child Information

Name of Child with Cancer(Required)
Child with Cancer’s Gender
MM slash DD slash YYYY
Date of Diagnosis
Diagnosis(Required)
Hospital(Required)
Social Worker(Required)
If first name is entered, last name is required.
Doctor
If first name is entered, last name is required.
Current Status(Required)
MM slash DD slash YYYY

Sibling Information

Sibling 1 Name
If first name is entered, last name is required.
MM slash DD slash YYYY
Sibling 1 Gender
Sibling 2 Name
If first name is entered, last name is required.
MM slash DD slash YYYY
Sibling 2 Gender
Sibling 3 Name
If first name is entered, last name is required.
MM slash DD slash YYYY
Sibling 3 Gender
Sibling 4 Name
If first name is entered, last name is required.
MM slash DD slash YYYY
Sibling 4 Gender
Sibling 5 Name
If first name is entered, last name is required.
MM slash DD slash YYYY
Sibling 5 Gender

Connecting with Candlelighters

Candlelighters offers resources such as financial assistance, support groups, a youth group (for ages 13–21), free family activities, and an annual family camp.
I would like to receive Candlelighters emails to stay up to date on resources.
I would like to receive a call from Candlelighters so I know what resources are available to me.
How did you hear about Candlelighters?

Family Data (Optional)

We are interested in learning more about our families, as well as collecting information that will allow us to apply for grant funding in the future. We greatly appreciate you providing answers to the following questions. Please note that these questions are optional and all answers will be kept confidential and will have no impact on the approval process for any of our programming.
Race & Ethnicity
Please check all that apply.
Military Status
Highest Level of Education for Parent / Guardian 1
Highest Level of Education for Parent / Guardian 2
Total Household Income:
Do you receive Medicaid?

 

Welcome to Candlelighters

We’re glad you are joining us to connect with other families, programs, and services for families diagnosed with childhood cancer.

We’ll be in touch if you asked us to contact you. If you have questions about Candlelighters, please contact Lisa. If you have questions about your diagnosis date, diagnosis, or treatment status, please contact your social worker at Doernbecher Children’s Hospital or Randall Children’s Hospital.

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