Request a Custom Get Your Gold On Badge
MOBILE USERS: You must reduce the file size of your smart phone photos by running them through before trying to upload them.

All completed badges are stored here:

Email address *
Parent or Guardian's First & Last Name *
Cancer Child's First & Last Name *
You MUST give a last name in order for us to sort your child into our gallery so you can find your finished badge.
Cancer child's name or nickname as you want it to appear on the badge: *
(9 characters MAXIMUM)
Upload a photo of your child, 1MB maximum: *
By submitting this form you confirm that you are the parent or legal guardian of this child, you own or have the rights to the photo you submitted. You give permission for Get Your Gold On to create a childhood cancer awareness badge from the photo and post it in our online gallery and on social media. *
If you would like your badge to be featured on our Instagram, please include a few sentences about your child's story (diagnosis, treatment, etc) along with any links to their advocacy or fundraising pages.
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service