Youth Inquiry Form
Please fill the application our as best you can.
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What is the child's first and last name?

 
How old is the child?

 
What city is the child from?

 
Are you the parent/guardian?

     
 
What is the parent(s)/guardian(s) first and last name?

 
What is the best phone number to reach you?

 
What type of illness does the child have?

 
Is the child inpatient or outpatient?


 
What hospital is the child attending?

 
What's ahead for the child's treatment? (i.e. sugeries, chemo, etc)

 
What hobbies or interests does the child have?

 
What are the child's dreams? (i.e. go to Hawaii, meet a celebrity, etc)

 
What's the child's favorite color?

 
What's the child's favorite music? (genre, song, or artist)

 
What is the child's favorite tv show?

 
What is the child's favorite movie?

 
Does the child have any bucket list items?

 
Please include any additional information about the child or concerns you may have about the process. Please describe where they are from and daily life. If they have sibilings/others in the household. When diagnosed, what stage, and what's ahead. What activities and hobbies the child liked to do before diagnosed, and how has the illness affected their ability to enjoy them now? How has the process been thus far?

 
Our team strives to make OAAT campaigns an enjoyable experience for both the child and their family.

We would like to ask the following from the parent(s)/guardian(s):
 
1.

Willing to allow OAAT member(s) to join hospital visits.
 
2.

Consent to be pictured/video recorded; used for web/print materials (website, social media, promotionalmaterials, etc.).
 
3.

Participation/attendance at OAAT events.
 
4.

Sharing of promotional materials for child.
 
5.

Willingness to allow child to join OAAT team members for events and activities (if child's health permits).
 
6.

Provide before illness and during illness pictures or videos of child.
 
We understand your schedule may be busy and may conflict with events and/or activities. It is a highly involved and interactive process and we would like to work together with the parents as much as possible to make the campaign special for the child and your family.

 
Thank You!

Thank you for taking the time to fill out our Youth Inquiry Form. We will get back to you within three business days regarding your submission.
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