Bag Request Form
Please complete the following form in order to request a bag from Shannon's Comfy Chemo Care Bag Project. Upon clicking submit, you will be notified that your response has been recorded. If you do not receive an email confirmation within 48 hrs of your request, please follow up by emailing
. All requested bags will ship out towards the end of the month. If a bag is requested at the end of the month, it may be pushed to the following months shipment. If you are local to me, you are welcome to pick up the bag and deliver it to your loved one personally. I am flexible! Thank you for understanding, as this is a one-woman show!
Requester Full Name
How did you hear about Shannon's Comfy Chemo Care Bag Project?
Full Name of Recipient/Fighter
Full Mailing Address of Recipient/Fighter (number, street, city, state, zip too please)
Male or Female
Fighter's Approximate Age (this helps with deciphering appropriate items to put in their bag)
What type of cancer diagnosis are they facing?
Breast Cancer (stage I, II, II)
Metastatic Breast Cancer (stage IV)
Head & Neck Cancer
will they need a comfort pillow to use between them and the seatbelt? This helps with surgery around the chest region as well as for a port (chemotherapy)
Yes, please include a pillow
No, they will not need a pillow for any of these reasons
Additional information (surgery date, chemo dates, radiation,etc)
Does the recipient/fighter have small children?
When a bag is requested, I ask that you consider making a contribution to Shannon's Comfy Chemo Care Bag Project in the fighters name. There is no way I would be able to continue this amazing project without the generosity of individuals like you. Have you donated to Shannon's
Donated via Paypal (Venmo, Zelle, Cash App, Facebook Messenger, etc) Approx. value of each bag is around $50.
Donated a check by mail (email me for address)
I have/will contribute items (via Amazon wish list or other)
I will visit
to check out ways that I may contribute.
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