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Notre impact
Découvrez comment vos dons aident les familles, les enfants et créent un avenir meilleur pour les enfants atteints de cancer.
Comment nous aidons
Histoires
Annual Report
Programmes et recherches que nous soutenons
Programmes et soutien
Découvrez toutes les façons dont nous soutenons les enfants atteints de cancer et leurs familles.
Demander de l’aide
Bourse d’études pour survivants
EmPower Pack
Fonds d’urgence
Additional Resources for Families
Fonds de bienfaisance
Comment donner?
Explorez des façons de faire un don, de recueillir des fonds ou de faire du bénévolat, et d’avoir un impact significatif dès aujourd’hui.
Planifier une collecte de fonds
Associez-vous à nous
Événements
Faire un don
Hommage
À propos de nous
Découvrez comment nous mettons en lumière le cancer infantile au Canada depuis 1987.
Mission et histoire
Notre personnel
Contactez-nous
Faire un don
Recherche
Recherche
Emergency Fund Form
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Social Worker or Interlink Nurse or Nurse Practitioner or Oncologist:
Social Worker or Interlink Nurse or Nurse Practioner or Oncologist Name
(Required)
Prénom
Last
Name of Hospital
(Required)
Alberta Children's Hospital
BC Children’s Hospital
Cancer Care Manitoba
Canuck Place
Children's Hospital of Eastern Ontario (CHEO)
CHU Saint Justine
CHU de Quebec-Université Laval
Credit Valley Hospital
Health Science Center (MB)
Holland Bloorview Kids Rehab
Horizon Health
IWK Health Centre
Janeway Children's Hospital
Jim Pattison Children’s Hospital
Kingston Health Sciences Centre
Leucan
London Health & Science Children's Hospital
McMaster Children's Hospital
Montreal Children's Hospital
Princess Margaret Hospital
Saint John Regional Hospital
Sick Kids
Southlake Regional Health Centre Hospital
Stollery Children's Hospital
Surrey Memorial Hospital
The Children's Hospital of Winnipeg
University of Alberta Hospital
Vancouver Children's Hospital
Victoria General Hospital
Vitalite Health Network
OTHER
Courriel
(Obligatoire)
Phone
(Required)
Child / Patient
Child/Patient Name
(Required)
Child First Name
Child Last Name
Diagnosis
(Required)
Date of Diagnosis
(Required)
Date of Birth
MM slash DD slash YYYY
Please confirm that your child is in:
(Required)
Active cancer treatment
Follow-up / After Care
Gender
(Required)
Male
Female
Prefer not to answer
Ethnic Origin
(Required)
Caucasian
Black/African/Caribbean
Latin American ( e.g., Costa Rican, Brazilian, Columbian, etc.)
South Asian (e.g., East Indian, Pakistani, Sri Lankan, etc.)
Middle Eastern (e.g., Saudi Arabian, Iranian, Egyptian, etc.)
East Asian (e.g., Japanese, Vietnamese, etc.)
Indigenous (First Nations, Metis, Inuit)
Other
Parent, Legal Guardian or Caregiver:
Parent, Legal Guardian or Caregiver Name
(Required)
Parent, Legal Guardian or Caregiver First Name
Parent, Legal Guardian or Caregiver Last Name
Courriel
(Obligatoire)
Phone
(Required)
Relationship between yourself and the other parent, legal guardian, or caregiver:
(Required)
Address
(Required)
Street Address
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
Preferred Language
(Required)
English
French
Gross Household Income Statement
(Required)
Combined Household Income of $59,999 and under per year (post-diagnosis)
Combined Household Income of $60,000 and over per year (post-diagnosis)
Please provide a brief description of how these funds will help your family:
(Required)
Would you like to receive communications from Childhood Cancer Canada?
(Required)
Yes
No
Would you like to be invited to local events & family outings?
(Required)
Yes
No
Date
MM slash DD slash YYYY
