Sign up for a CLIMB THE HILL Day

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for signing up for a Climb the Hill Day on September 18!

Climb the Hill

- Leave your parents behind: Congressional meetings are led directly by kids, teens, and young adults.
- Who can join as a Climber: Patients, survivors, and siblings ages 7 to 25. Other allies are welcome too!
 - Full support: We provide all the necessary training and guidance—no prior experience required. Our training specialist Jenn Flynn will be in contact prior to " Climb the Hill" day to schedule an introductory one on one zoom and then a follow up group training zoom.

Name of Climber: First and Last Name *

Name of parent -- if communication will be to the parent -- first and last name

Email *

Did you provide the climber email or parent email?

Climber

Parent

Clear selection

Cellular Phone # of Climber or if the Climber is too young please send Cellular phone # of guardian. *

Climber's Birthday *

YYYY

Address of Climber : Street name, State *

Address ZIP code *

What is the Climber's connection to pediatric cancer? *

Does the Climber have Mobility limitations or requests for other accommodations?

Is there anything else you would like us to know?

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Kids v Cancer.

Does this form look suspicious? Report

Forms