Join

the Candlelighters NYC family

 

Sign Up Form

Candlelighters NYC is open to all families with children who have or have had cancer in New York City. All of our events and outings are completely free for our families. If your child, or a child that you know, was recently diagnosed with cancer, we are here to help. Please fill out this form to join the Candlelighters NYC family.

Child's Full Name (required)

Child's Date of Birth

Child's Nickname

Type of Cancer

Hospital

Date of Diagnosis

Child's Website

Status Of Treatment

Other Relevant Health Info

Family/Parent Name(s)

Relationship with Child

Home Address

Home City

Home State

Home Zip

Home Country

Home Phone

Email Address

Mobile Phone

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Home Phone

Emergency Contact Work Phone

Emergency Contact Mobile Phone

Sibling Names(separate with commas)

Sibling Genders

Temporary Housing Name

Temporary Housing Address

Temporary Housing City

Temporary Housing State

Temporary Housing Zip

Temporary Housing Phone

Length of Time in Temp Housing

How did you hear about Candlelighters, NYC?

Testimonial

We met Barbara from Candlelighters, NYC through another family from our area who had treatment at Memorial Sloan Kettering Cancer Center in NYC.  We literally met her when Trevor was having surgery.  She came to the hospital with blankets and pillows for Marc and I to sleep on while Trevor was in the Pediatric Intensive Care Unit recovering.  She brought Trevor toys to make him smile when he came out of surgery.  Barbara, her husband Stewart, and her sweet dog Uno welcomed Ava, Trevor, Marc and I into her home on many occasions and treated us like family.  Barbara is a wonderful person who does amazing things for kids and their families being treated in the NYC area.  It’s tough to be away from family for treatment.  We think of them as our NYC family.  We can’t thank them enough for their love, support, advice, gifts and the little creature comforts (like a nice glass of wine).

Sara Elizabeth Schweigert