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 comfychemocarebagproject@gmail.com. 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!
Email Address *
Your answer
Requester Full Name *
Your answer
How did you hear about Shannon's Comfy Chemo Care Bag Project? *
Your answer
Full Name of Recipient/Fighter *
Your answer
Full Mailing Address of Recipient/Fighter (number, street, city, state, zip too please) *
Your answer
Male or Female *
Fighter's Approximate Age (this helps with deciphering appropriate items to put in their bag) *
Your answer
What type of cancer diagnosis are they facing? *
Required
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) *
Additional information (surgery date, chemo dates, radiation,etc) *
Your answer
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 comfychemocarebagproject.org ? *
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