CBTF Jenna's Friendship Circle

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your interest in joining Jenna's Friendship Circle, a new program that connects survivors and friends through the mail. Today, we are all used to communicating on the computer and phone, through text, zoom and email but there is still something special about receiving a note, card or gift through the mail.

Please fill out this form so we can learn a little bit more about you! When you join Jenna's Friendship Circle, you will receive a letter introducing you to the program. Once you join, CBTF survivors and friends will send personal notes and small gifts to your home every other month. The Jenna's Friendship Circle aims to encourage kindness and help members know they are not alone. Thank you for joining! Contact bjones@cbtf.org with questions or comments.

Your Full Name *

Nickname or how you like to be addressed

Your full address (Street, Apt#, City, State, Zip) *

Your age *

Your diagnosis? *

Are you *

In treatment

Out of treatment

Your birthday (month, day, year) *

Best contact email for you *

Best contact phone for you *

If you are under 18, please provide the name and contact information (email and phone) for your parent/caregiver. If you are 18+, please put N/A. *

What are some of your favorite activities? *

What is your favorite color? *

What is your favorite food? *

What is your favorite animal? *

What do you like to read or watch? *

Is there anything else you want to share?

Please choose the following statement that applies to you.

I am over the age of 18 and agree to participate in the CBTF Jenna's Friendship Circle. I give CBTF permission to share the information I provided in this form with the CBTF staff and Friendship Circle Volunteers. I understand my comments and any additional photos or information that I provide as a Friendship Circle member may be used for other marketing/promotional events.

I am the parent/guardian of the CBTF Jenna's Friendship Circle applicant. I agree to allow my child to participate in the CBTF Friendship Circle. I give CBTF permission to share the information provided in this form with the CBTF staff and Friendship Circle Volunteers. I understand my/my child's comments and any additional photos or information that I provide as a Friendship Circle member may be used for other marketing/promotional events.

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Children's Brain Tumor Foundation. Report Abuse

Forms