Fist Bump Application

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Fist Bumps are intended to support children who are patients at Lurie Children's Hospital or are battling Adrenal Cortical Carcinoma.

Supporting patients at LCH (Chicago) or battling Adrenal Cortical Carcinoma.

Child's Name *

First and last name

Child's Age *

Child's Diagnosis *

Please provide full name of diagnosis (e.g. Adrenal Cortical Carcinoma instead of ACC)

Address *

Full address including building number, street, town, state, and zip code (123 School St., Anytown IL 60000)

Parent Name *

First and last name

Parent email *

Biography

Please provide a short description of your journey. Please also tell us about the child (e.g. likes, hobbies, interesting facts). We will use this biography on our website and our social media sites. Also, please send 10-12 photos of the child both in and out of treatment to tpalzet@fearnotnation.org.

Please include links to your preferred Fist Bump gift totaling up to $200

Please do not use my child's image or story on social media.

By selecting this option you signify that you do not consent to your child's image or story being used on social media

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