Future NolaBee Patient Spotlight 
Do you know or have a child who has faced the unthinkable? Who has proven time and time again to be one of the bravest souls you know? Want to help families who will endure the same pain, obstacles or struggles your little one has?  Teaming up with NolaBee aims to do just that. We want to support others in the only way we know how, with art.

Submit a story here to raise awareness for their condition and help NolaBee share their story by answering the following questions. 

By submitting an application, you understand that the patient and their family will not benefit from this line financially. Sharing of stories is done so voluntarily, and patients will only receive the attention their stories bring. NolaBee will gift each patient and their family with free pajamas from their line and be given a permanent 50% off personal promo code for future purchases from their collection. 

Other than the child's first name and diagnosis, no personal information will be shared.
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What is your full name? *
What is your email address? *
What is a good number to reach you? *
What is your username on social media platforms? *
Please check your preferred way to reach you, check all that apply *
Required
What is your relationship to the patient you want to raise awareness for?  *
Are you the child’s legal guardian? *
Do you have joint custody? *
If so, will there be any issues regarding the choice of your little one's story or exposure?
If no, please include guardian's name and contact information here for permission to move forward. 
What is the child’s name? *
What is the child's DOB? *
DD
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MM
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YYYY
What is the child’s diagnosis? *
When was the child diagnosed?  *
How has the child’s condition impacted their life?  *
Are there any special days of the year that you celebrate or are an anniversary due to your child's diagnosis? ( First treatment, news of diagnosis, news of remission, surgeries, etc.) *
What makes this patient special? *
Give a brief summary about the patient, his/her medical history, and why you want their story told. How do you think their story will help others? *
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