Welcome to the Abtaluna - Requester Form
The community in the UAE is here for one another. Super Kids and family members, please fill this form to define your request.
Please note that your data will be treated with utmost confidentiality and will never be inappropriately shared or misused.
Apologies, if your family has not been impacted by Childhood Cancer then please do not fill this form as this campaign is raising awareness only on Childhood Cancer.
Your Full Name  *
Gender *
Your Child's Full Name  *
Phone number *
Email *
What applies to you? *
Which emirate do you reside in? *
If you do not live in the UAE, then where?
What applies to your Super Kid? *
Please tell us more about your child: their age, type of cancer, date of diagnosis, current phase etc.. *
At which hospital is/was your child getting treated? *
What service are you asking for and what is the age of the individual who will benefit from this service? Please be as clear and detailed as possible. If it is music lessons for example, please clarify what type, frequency required etc..  *
This is to confirm that Abtaluna will not be held responsible for any services provided to you by third party entities or individuals. *
Required
Any other remarks/questions/suggestions? We're all ears
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