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See how your donations help families, empower children and create brighter futures for children with cancer.
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Learn how we’ve been shining a light on childhood cancer in Canada since 1987.
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Please fill out the fields below to register with Childhood Cancer Canada.
Parent / Guardian information
Parent / Guardian Name
(Required)
Parent / Guardian First Name
Parent / Guardian Last Name
Email
(Required)
Phone
(Required)
Address
(Required)
Street Address
Address Line 2
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
Second Parent / Guardian Information
Second Parent / Guardian Name
Second Parent / Guardian First Name
Second Parent / Guardian Last Name
Email
Phone
Address
Street Address
Address Line 2
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
Cancer Hero's Information
Name
(Required)
Child's First Name
Child's Last Name
Date of Birth
(Required)
MM slash DD slash YYYY
Gender
(Required)
Male
Female
Prefer not to answer
Diagnosis
(Required)
Age at diagnosis
(Required)
Hospital
(Required)
Name of Social Worker
(Required)
Social Worker First Name
Social Worker Last Name
Email
(Required)
Enter Email
Confirm Email
Siblings (name and age)
Do you want to receive a tablet for your child?
Yes
No
Would you like to receive important information from Childhood Cancer Canada?
Yes
No
Primary language(s) spoken in the home
Is there anything else you would like to tell us about yourself:
How did you hear about Childhood Cancer Canada?*
Hospital
Social Worker
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Name
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