Family Party Application

Eligibility Criteria

To qualify for assistance, families must meet the following requirements: ✔ U.S. Citizen or Resident
✔ Child must be actively in treatment or within five years post-treatment
✔ Child must have a diagnosis of pediatric cancer
✔ Child must be between the ages of 0-18
✔ Child must have been diagnosed before turning 18

This application is only for family parties. This is not for Leia’s Kids’ financial assistance or mental health retreats.
Please note that you will be notified when your family is next in line to receive a party. Due to a high volume of applications, we appreciate your patience as we do our best to assist all families in need. Thank you!

    Family Information Questionnaire

    Child Information

    Child’s Gender

    Is the child actively receiving treatment?

    Is your child’s treatment being facilitated at a hospital?

    Can the child be around groups of people?

    Does your child have any physical restrictions?



    Family Information

    Household Size

    How many people currently live in your household?

    Does the child have siblings?



    Parent’s Information


    Party & Celebration Details

    Parties are for immediate family members only. By request only, can we extend the invite list.

    How many people do you plan to have present?

    Are there any food allergies or dietary restrictions we should be aware of?

    Will this party be used for: (Check all that apply)
    Birthday CelebrationEnd of Treatment CelebrationRinging the BellA Party to Celebrate & Have FunA Pick-Me-Up for the FamilyDecor to decorate the hospital room

    Does your family prefer:
    Overnight stay at Great Wolf Lodge (or similar venues)An at-home party with a characterSupplies shipped to your home to match the themeTickets to a sports game or theme parkA donation to supply the dream partyA child or family photoshootA shopping experience (American Girl, Dicks etc)


    Family’s Cancer Journey

    How has this journey impacted your family’s daily life?

    Nomination & Verification



    Confidentiality Statement

    Your responses to the following questions will not disqualify you from receiving assistance. This information is collected solely for data collection and program expansion purposes. All responses will remain confidential and will not impact your eligibility for assistance.

    Household & Financial Information

    Household Income

    What is your estimated annual household income??
    Under $25,000$25,000 – $49,999$50,000 – $74,999$75,000 – $99,999$100,000 – $149,999$150,000+

    Additional Financial Burdens

    Financial Impact of Cancer

    Has a cancer diagnosis impacted your household financially?
    If so, please describe how (e.g., loss of income, increased medical expenses, caregiving responsibilities, etc.):

    Has a parent/caregiver stopped working or reduced hours due to your child’s illness?
    YesNoReduced Hours

    Financial Challenges

    Have you faced any of the following financial struggles due to your child’s illness? (Check all that apply)
    Difficulty paying rent/mortgageUtility shutoff noticesCar payments or transportation issuesMedical debtBankruptcyEviction riskOther