BFF Bag Request

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BFF Bag Request

Please complete the following information to request a BFF Bag for your child.

Email *

Child's Name *

Parent/Guardian Name *

Parent/Guardian Phone Number *

Address *

Birth Date - Child *

YYYY

Gender - Child *

Child Tee Shirt Size *

Child's Shoe Size - if shoes needed

Child's Favorite Toys/Wishlist *

Any items your child needs (clothes, shoes, medical items, etc)

Cancer Type *

Hospital Affiliated with Treatment *

How do you hear about us? *

Does your child have a social media group we can follow? If so what platform and name is it under?

I grant permission to the Brantley Francis Foundation, an Illinois not-for-profit corporation, to use the image and information shared about my child, and any background or personal information provided by myself, in social media and marketing publications including but not limited to: Videos, Email, Brochures, Flyers, Newsletters, General publications, website, social media. I waive any right to inspect or approve any finished matter that may be used in conjunction now or in the future, whether that use is known or unknown to me, and I waive any right to royalties or compensation arising from or related to the use of the image. *

Yes, by selecting this option I agree to the above statement. This will serve as my electronic signature for authorization

No I do not wish to allow BFF to share images etc.

Other:

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