Riley's Army Family Sign Up
Riley's Army is a 501(c)(3) not-for-profit organization with a mission to support families affected by pediatric cancer in Eastern North Carolina. Our services include financial and social support for families. Due to the financial strain of pediatric cancer, each Riley's Army family has a $2,000 emergency fund to be accessed for bills such as rent and utilities, car repairs, gas cards, and grocery cards. Please note that a 72 hour notice is required in advance for financial support. These inquiries can be sent to our family liaison, Emleigh Hughes, at (252) 412- 8191.
Riley's Army is committed to serving our families. We host events for families to interact, with hopes that you can find a community to relate to and lean on during your journey with pediatric cancer. Information for these events will be sent out via email as well as on our facebook page. Once you sign up, you can request to join our Riley's Army family facebook group, which is exclusive to our families only for your privacy. The facebook group is called "Riley's Army private family group."
It is a gift to serve and know each and every Riley's Army family. If we can help during your journey, let us know. If it is beyond our capacities, we will try and direct you to someone who can help. Thank you for letting us serve you!
Please fill out the form below so we can add you to our secure password-protected database. This information is shared ONLY with our family liaison, Emleigh Hughes. If you do not wish to fill out online, you can print this form by right clicking, selecting "print", and returning to social worker.
What is your child's name and birthdate?
Please list parent's names, preferred contact method, and addresses. It is recommended, but not required, that you provide at least one email and phone number. Please note that if you do not provide an email, you may not receive emails sent out to families regarding events, policies, and updates.
Does the child have any siblings? If so, please list them as well as their ages.
Please give a brief description of child's diagnosis including diagnosis date.
Please list any food allergies of the patient or anyone who may be impacted by meal deliveries or food served at events. Please let us know if your child is neutropenic at any time via text message so we can take special precaution in making sure they can have a meal.
Are there any additional ways we can help or do you have any questions?
By checking the box below, you voluntarily accept help from Riley's Army and know that you can decline services at any time, as you are under no obligation to accept services or share personal information. You acknowledge that services are provided by volunteers and family liaison with approval from the board and understand that there are limitations to such services. You will provide 72 hours notice for financial support requests, and will agree to provide feedback and report any concerns about Riley's Army to the family liaison. You understand that Riley's Army reserves the right to decline services at any time.
I have read the information above and agree
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