family ASSistance

I spent one and a half years in the hospital fighting cancer. My mom was by my side practically the whole time and my dad for most of the time.  But my parents also had to take care of my family, to stay alive. I know how important it is to stay with your child in his/her time of need. If you also feel this way, but need financial assistance, then fill out the forms below.

We will help you and your child with love,

  

Elana

Child's Full Name *

Parent Email Address *

Phone Number *

Child's Date of Birth *

Date of Diagnosis

Official Diagnosis *What type of cancer has the child been diagnosed with?

Treatment Status

In TreatmentRelapse TreatmentRemission / NEDAngelOther

Other

Parent/Guardian Name *

Are you the child's parent or legal guardian?YesNo

Mailing Address

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabwe

How did you hear about us?

Affiliated Hospital's name

Social worker or hospital contact name

Social worker or hospital contact number

Social worker or hospital contact email

If you have a fundraising page for your child, please provide the link.

Please include a link to the child's social media (Instagram, facebook, etc)

Do you authorize your child's pictures and story to be posted on KCCF's social media and other public or non-public KCCF materials and communications? *YesNo

What kind of services would you like to receive from KCCF?

Please tell us about your child (250 word limit) *0 / 250

Disclaimer *

I agreeI have read, understood, and agree with the above statements. I want to receive communications (newsletters, alerts, announcements, etc.) from KCCF. While KCCF strives to help as many families suffering with childhood cancer as possible, each case is reviewed and accepted on a case-by-case basis. There is no guarantee of assistance.

Submit Form

Please do not fill in this field.

Payable to:

Koenig Childhood Cancer Foundation

Mail to:

1175 York Ave., Suite 15E New York, NY 10065

T: 917-765-6272 E: join@thekccf.org