Live Like Liv Foundation Grant Application
The Live Like Liv Foundation is dedicated to supporting children, teens, and families impacted by childhood cancer. Grants may be used for family support, medical expenses not covered by insurance, travel, or meaningful experiences that bring joy and comfort during treatment or recovery.
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Recipient's Information:

Child's Full Name:
Date of Birth:
Parent/Guardian Name(s):
Provider/Physician:
Child Life Specialist/Social Work Contact:
 Contact Phone:
 Contact Email:
Grant Request Details 

Amount Requested:$
Purpose of Grant (check all that apply):
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Please describe in detail how this grant will support your child and family:
Additional Information

Has your family received support from the Live Like Liv Foundation before?
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If yes, please describe 
How did you hear about the Live Like Liv Foundation?
I authorize the release of our names and photos/images of our family that we have provided or approved, for the promotion of services we have been provided by the Live Like Live Foundation. 

I authorize the releases of our child's diagnosis and place of treatment information we have provided and approved, for the promotion of services provided by the Live Like Liv Foundation.
 
I authorize Live Like Liv Foundation to reach out to the approved contacts.
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Print Name: 
Signature: 
Date signed:
Submit
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