Care Package Application
Hello! You will be asked specific questions about your child's diagnosis to ensure they qualify for a package. This survey will provide us with details about your child's interests in order to create the perfect package!  If you have any questions, send us a DM on Instagram at @love.for.ladybug for the fastest response, or email at loveforladybug@gmail.com

We'd love to share your pictures/videos on our social media! If interested, please send us pictures of your child with their care package on our instagram at @love.for.ladybug or via email at loveforladybug@gmail.com

Thanks for helping us spread #PositivityForPediatricCancer!
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Email *
Your First and Last Name *
Child's First Name *
Child's Birthday: *
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DD
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Child's Diagnosis: *
Date of Child's Diagnosis: *
MM
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DD
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YYYY
Name of Hospital Child is/was treated at: *
Name of Child's Social Worker:
Email of Child's Social Worker:
LINK to Parent and/or Child Social Media (this will ensure they qualify for a care package): *
Address to send care package (*Must be address where child is currently located) *
Phone Number *
Child's Favorite Color(s)
Child's Favorite Movies/TV Shows
Child's Favorite Princess or Characters
Child's Favorite Hobbies
Anything common things you do NOT want in a care package? (This can be things you have an abundance of: blankets, crayons, etc):
Anything else we should know?
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