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

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 info@jasonsfriends.org 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. 

Family Enrollment Form

Fax: (307) 265-4668

Mail:

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

Telephone: (307) 235-3421

FORMS FOR FAMILIES ALREADY ENROLLED

Travel Reimbursement Form

Household Bills Payment Request Form