Get ready to apply
CURE Childhood Cancer
Family Outreach and CURE Tote
What you get
Family Outreach and CURE Tote for your child and your family. Ask whether requests are open.
- Who starts it
- You
- How it’s sent
- Online, on their website
- Your time
- An hour or so
- Last checked
- Aug 27, 2026
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What their form asksA preview, so you can gather things first. Fill it in on their site.
Open their application ↗ Checked Aug 27, 2026What the form asks for
CURE Family Information FormSELECT ONEYour First NameYour Last NamePatient's First NamePatient's Last NameDate of BirthAgeGenderPatient's EthnicityDiagnosis TypeDate of DiagnosisTreatment StatusDate of relapse/progressionParent/Guardian First NameParent/Guardian Last NameRelation to PatientCell PhoneEmail AddressStreet AddressCityStateZip CodeWould you like to add contact information for child's other parent/guardianParent/Guardian NameRelation to PatientCell PhoneEmail AddressAddress (leave blank if same as parent 1)Siblings of Patient — NameSiblings of Patient — M/FSiblings of Patient — BirthdateIs your child currently receiving treatmentHas your child completed treatmentDate completed treatmentHas your child had their first Survivorship Clinic appointmentWhen is your child expected to begin treatmentTreating HospitalDid you receive a CURE ToteSocial Media or Caring BridgePlease let us know how you learned about this patient information form
After you send
If a CURE Tote was not received, ask the treating social worker for one; CURE does not publish a response timetable for the form.