Get A Cube | Ethan's Ohana

Application For A Cube

Child's Name

Parent/Guardian First Name

Parent/Guardian Last Name

Child's Diagnosis

Date of Diagnosis

Child's Support Page URL (Facebook, Instagram, Caringbridge, etc.)

Hospital Affiliated with Treatment

Social Worker/Child Life Specialist Name

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

How did you hear about Ethan's Ohana?

To help us cover the costs of shipping, we would like your permission to share the opportunity to sponsor your child's cube with our supporters. The only things that are shared with a sponsor are the first name of your courageous child, the type of cancer they are fighting, and the state you live in. No other information is ever shared. Do we have your permission to find a sponsor for your family?

Yes

Thanks for submitting!