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
You may fill this form in online, however, after completing it will need to be printed for parent/guardian signatures. Please submit by scan/email for faster receipt to email@example.com or you may fax/mail the form to Jason's Friends Foundation. A copy of your driver's license is required.
Please note: Direct referrals that do not come from the hospital social worker require a written diagnosis from the hospital/doctor.
Fax: (307) 265-4668
Jason's Friends Foundation
340 West B Street, Suite 101
Casper, WY 82601
Telephone: (307) 235-3421