The Good Box Application

for Parents and Caregivers

One Mission’s Good Box Care Packages provide self-care items to parents of children with pediatric cancer reminding them to take care of themselves.

*Parent(s) must have a child aged 18 or under currently in cancer treatment. Applications without sufficient information to confirm pediatric cancer diagnosis, or where diagnosis cannot be confirmed, will not be considered.

"*" indicates required fields

Name of person filling out application*
Are you requesting a Good Box for both parents or only one parent?*
Name of Good Box recipient's child (patient)*
MM slash DD slash YYYY
Is child (patient) currently in treatment for pediatric cancer? Child must be in treatment (and confirmed by medical professional) for application to be considered.*
Name of medical professional who can confirm diagnosis*
Please select the item(s) you think the parent(s) would be most interested in:
Best mailing address for package (must be an address that can accept packages)*
Would you be willing to let One Mission share your quotes and/or photos for marketing purposes to show our donors the impact their donations make?*
The_Good_Box