KIDSCAN Club Member Application
KIDSCAN is part of the Cancer Alliance of Naples (CAN) which is a 501(c)3 registered charity. KIDSCAN CLUBS are part of the KIDSCAN junior organization. Community Service credit is given for every hour of participation at meetings and events. It is up to each KIDSCAN Club member to sign the meeting or event attendance sheet to ensure credit hours are given.

The mission of CAN is to help make the lives of Collier County residents being treated for cancer and the lives of their spouses and children easier by paying rent, utilities, food, gas, and other financial needs they may have. The mission of KIDSCAN CLUBS is to help CAN help the children who have cancer in the Collier and Lee County areas.

KIDSCAN CLUBS (1) Raise money for college scholarships for local high school graduating seniors who are battling cancer or who have a member of the family with cancer; (2) Assist CAN and KIDSCAN in its mission and fundraising endeavors to help local cancer patients; including funding support for CAN’s annual cancer children’s holiday party and family retreat, bike rides and other events.

Please fill out the information below to be a KIDSCAN CLUB member. Each student is asked to put in 15 hours to be part of the club. Attending meetings and participating in events earn credit hours. KIDSCAN DUES are $15. This pays for the official KIDSCAN tee shirt in our school colors and helps with KIDSCAN costs such as banners and posters.

You might be working around sick children and adults. Drugs, alcohol and tobacco are strictly prohibited. You will also be required to sign the attached confidentiality agreement. Diagnosis, treatment and prognosis of a child’s cancer are often not what parents of these children wish to be made known either to the child or the public. You may also know someone in school whom CAN is helping. This, too, must remain confidential. This information sheet will be kept confidential and placed on file at the office of the Cancer Alliance of Naples.

First Name
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Last Name
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Address
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City
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State
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Postal Code
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Phone
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Email
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High School
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Grade
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Tee Shirt Size
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Club Member Dues $15
(Checks must be made payable to "Cancer Alliance of Naples") Please note: If you are choosing the credit card option you will receive a secure link via email to safely make payment. Mail checks to : KIDSCAN C/O Cancer Alliance of Naples- 3384 Woods Edge Circle Suite #102. Bonita Springs, FL. 34134
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Confidentiality Agreement
In the course of being a member of a KIDSCAN Club, you may become aware of a specific diagnosis, treatment or prognosis of a child’s illness. Diagnosis, treatment and prognosis of a child’s cancer are often not what parents of these children wish to be made known either to the child or the public. Therefore, anything you see or hear in a KIDSCAN Club meeting or event, which pertains to a specific child’s situation, must remain in strictest confidence. It is not to be shared with family or friends. You may also discover that someone you know or who attends your school is being assisted by CAN. This, too, must remain confidential. The student you know may not wish it to be known by others that help is being given to that family. By signing below it is understood that any indiscretion of the above is grounds for immediate termination as a member of a KIDSCAN Club.
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