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Wagon Nomination

To be eligible, the wagon must be intended for a family with a child no older than 21 fighting cancer.  We know that long clinic appointments don’t stop after “end of treatment” so we will give a wagon to any family within 5 years of their end of treatment date.

Nomination Form - HYP!

Child's Name(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY
Color, characters, toys, etc.
Please include their name, age, and favorites.
Your Name(Required)
Parent/Guardian Name
If applicable
Shipping Address(Required)
Shipping address is:
Include lap tray?(Required)
Include portable charging brick?(Required)
Allow child's photos to be shared online in an effort to raise more money so more kids can get wagons?(Required)
This field is for validation purposes and should be left unchanged.