The Junior Good Box Application

for Patients

One Mission’s Junior Good Box Care Packages are filled with books, games, arts & crafts, and toys that bring fun, joy, and smiles to patients, right when they need it most.

*Patient(s) must be age 18 or under and 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*
Name of patient Junior Good Box application is for*
Is patient currently in treatment for pediatric cancer? Patient must be in treatment (and confirmed by medical professional) for application to be considered.*
Name of medical professional who can confirm diagnosis*
Patient's date of birth*
Patient's gender*
Patient's favorite colors (please choose all that apply)*
Best mailing address (must be a location that can accept large 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