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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
EmPower Pack Form
URL
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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
Courriel
(Obligatoire)
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
Courriel
Téléphone
Adresse
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
Nom
(Obligatoire)
Child's First Name
Child's Last Name
Date of Birth
(Required)
MM slash DD slash YYYY
Gender
(Required)
Male
Female
Another gender
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 (e.g., First Nations, Metis, Inuit, etc.)
Other
Diagnosis
(Required)
Date of Diagnosis
(Required)
Please confirm that your child is in:
(Required)
Active cancer treatment
Follow-up / After Care
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
University of Alberta
Vancouver Children's Hospital
Victoria General Hospital
Vitalite Health Network
Other
Name of Social Worker
(Required)
Social Worker First Name
Social Worker Last Name
Courriel
(Obligatoire)
Enter Email
Confirm Email
Sibling #1 Name
Sibling #1 Age
Sibling #2 Name
Sibling #2 Age
Sibling #3 Name
Sibling #3 Age
More than 3 siblings? Please add their names and ages below.
Would you like to be invited to local events and family outings?
(Required)
Yes
No
Do you want to receive a tablet for your child? Please note that children under 3 years of age will not be provided with a tablet.
(Required)
Yes
No
Would you like to receive important information from Childhood Cancer Canada?
(Required)
Yes
No
Preferred Language
English
French
Is there anything else you would like to tell us about yourself:
How did you hear about Childhood Cancer Canada?*
Hospital
Social Worker
Support Group
Internet Search
Social Media
Event
Other
Untitled
First Choice
Second Choice
Third Choice
