CURE Childhood Cancer
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Support for Families Fighting Cancer

Family: A group of people who genuinely trust, care about, and look out for each other. At CURE, we stand united with every family facing the challenges of pediatric cancer. Your family becomes part of a larger family, the CURE family, and our support for families with cancer never wavers.

Family Resources
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Early Outreach
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Family Emergency Assistance
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Open Arms Meal Program
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Counseling
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Bereavement Care
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Family / Patient Information

If your child has been diagnosed with cancer and you would like more information from CURE, please complete this form. (Para completar el formulario en español,  haga clic aquí .)

" * " indicates required fields

Patient's First Name *
Patient's Last Name *
MM slash DD slash YYYY
Patient's Ethnicity *

MM slash DD slash YYYY
Treatment Status *
MM slash DD slash YYYY
Parent/Guardian First Name *
Parent/Guardian Last Name *
State *
Would you like to add contact information for child's other parent/guardian?
Address (leave blank if same as parent 1)
Siblings of Patient
Name
M/F
Birthdate
Is your child currently receiving treatment? *
Has your child completed treatment?
MM slash DD slash YYYY
Has your child had their first Survivorship Clinic appointment?
Treating Hospital *

Did you receive a CURE Tote?
We'd like to follow your child's journey
Please let us know how you learned about this patient information form? *

This field is for validation purposes and should be left unchanged.

Your action today can bring hope and help to families battling pediatric cancer. Together, we can make a difference with support for families with cancer.

Join us in this crucial fight – because no family should face this challenge alone.

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