Enrollment

 

QUALIFYING REQUIREMENTS FOR OUR PROGRAM

  • Child must be under the age of 21 years old
  • Child's diagnosis must be a brain tumor, spinal cord tumor or childhood cancer
  • Custodial Parent/Guardian must be a US citizen
  • Custodial Parent/Guardian must be a Wyoming resident
  • Custodial Parent/Guardian must provide a Wyoming Driver's License

 

ENROLL IN OUR PROGRAM

        ENROLL ONLINE HERE

You may also email, fax or mail the forms to Jason's Friends Foundation. To print forms, please select each form below:

Family Enrollment Form
Agreement Form
HIPAA Release of Information Form

A copy of your driver's license is also required.

Jason's Friends Foundation
340 West B Street, Suite 101
Casper, WY 82601

Fax: (307) 265-4668

Telephone: (307) 235-3421

Please note: Direct referrals that do not come from the hospital social worker require a written diagnosis from the hospital/doctor. 

 

FORMS FOR FAMILIES ALREADY ENROLLED

Travel Reimbursement Form

Household Bills Payment Request Form