Super Sammy's Challenge Coin Order Form
Thank you for your support in Sammy's battle with medulloblastoma, a form of pediatric brain cancer. Please fill out this form to receive an invoice for your purchase. All profits from each coin will go towards the Puma family to help with the growing costs associated with Sammy's cancer journey.

Each coin is $20. Available to either be shipped or picked up locally in Phoenix, AZ.

These coins measure 1.75". They are a custom design that represent Sammy's battle, and to honor the stand you have taken to be a warrior along side him and our family in this journey.

On one side of the coin you will see the traditional cancer ribbon, this is a symbols used to represent cancer awareness. Each cancer ribbon is a different color to represent a specific type of cancer. This ribbon is GOLD to represent all forms of childhood cancer. Childhood cancers are grouped together when talking of statistics and raising awareness. Yet there are dozens of types of childhood cancer. GOLD represents them all. We chose GREY for the background, as GREY represents all forms of brain cancer. On this side you will see #supersammystrong which is the hashtag we have chosen for Sammy's fight. Medulloblastoma for his subtype of brain cancer. Along with Childhood Cancer. Around the top edge it reads NO ONE FIGHTS ALONE. We truly believe this fight can not be won by fighting alone. He needs an army of warriors standing with him daily, lifting him up. Along the bottom it reads WWW.ADVENTURESOFSUPERSAMMY.COM which is where you can find his entire fight documented. But also where you can find alternative ways to support his journey.

On the other side of his coin you will see his logo, with his SS showing proud. Again showing the colors of GOLD and GREY. Along the top of the coin reads "FOR THIS CHILD I HAVE PRAYED" 1 SAMUEL 1:27. Please do just that. Pray for our child daily. Anytime you hold his coin, pray for Sammy. Anytime you hear reference to this verse, remember it is from 1st Samuel and to pray for our Samuel, Super Sammy. We believe in the power of prayer, and know God will answer in his time. On the right and left sides there is the GOLD ribbons again to represent his fight. And finally the bottom of his coin is I AM A WARRIOR FOR SUPER SAMMY. Thank you for being just that, a warrior for our son. Standing along side him, following him and supporting him every step of his journey. Supporting our family.

If you would like to make a donation and not purchase a coin, you can do so by visiting or

For more on his journey and other ways to support our family visit or

Thank you being a warrior along side of Super Sammy, and our family, in his fight against brain cancer.

Coin Preview
Your answer
PayPal Email (if no PayPal, use your current email address)
Your answer
Name on PayPal account (use N/A if no PayPal)
Your answer
Shipping Address (be sure to include entire address)
Your answer
Shipped / Local Pick-up
Optional : Additional donation to be added to invoice
TERMS : I understand this is a fundraiser to support the Puma family in Sammy's journey. All sales are final. Please allow up to 4 weeks for shipping, but will likely be shipped sooner.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms