Request edit access
*Shining Star*: About Me!
If you are the parent/guardian of a patient or a patient yourself and are interested in the chance to walk down the runway with your favorite fairytale character(s), please fill out this form to tell us a bit more about your shining star and what makes them the amazing person they are!
Name *
Your answer
Age *
Your answer
Phone Number: *
Your answer
Email address: *
Your answer
Emergency Contact Name: *
Your answer
Emergency Contact Phone Number: *
Your answer
Special Accommodations *
Your answer
Allergies *
Your answer
Favorite Princess/Superhero/Fairytale character(s)?
Your answer
Favorite Color?
Your answer
Favorite Activity or Sport?
Your answer
What would you like to be when you grow up?
Your answer
Who/What inspires you the most?
Your answer
If genie granted you 3 wishes, what would you wish for?
Your answer
A place you would love to travel to/what would you do there?
Your answer
What would be your first decree as a king/queen/superhero?
Your answer
What is the greatest lesson you have learned or want to teach others?
Your answer
Favorite song that you would love played when you walk?:
Your answer
Would you like any certain princess/superhero to spend time with you or walk you down the runway? If yes, please state who below! (*See section Princesses, Superheroes and Fun- Oh, My! in patient package For a complete list of characters available): *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Crowns Against Cancer. Report Abuse