Starlight Family Application

Starlight Children’s Foundation is excited to invite you to join us as a Starlight Family. Our family programs invite children through the age of 18 with chronic/serious illnesses to debilitating injuries, and their families, to attend special outings and events. Teens and young adults ages 13-20 are invited to join Starbright World, a global online community that allows them to connect, share and support one another through their health journey. To learn more, visit: Since our programs are a function of sponsorships we receive, Starlight Families will receive an alert when an outing becomes available in their community. Starlight is committed to protecting the privacy and confidentiality of the personal information collected from our families, volunteers, donors and employees. The information you provide will be used to deliver services and to keep you informed, and will never be sold or disclosed to third parties.
* Required

Child's Information

Parent/Guardian Information

Household Member Information

Referral Source

Demographic Information (Optional)

Starlight seeks sponsors to help fund the Great Escape program. Some of these sponsors are interested in some information about the families we serve. We do not collect this information as measures for acceptance into the Great Escapes program, but it would help us secure funding from some sources. Do not feel obligated to answer the following questions.

Never submit passwords through Google Forms.