A Healing Grace

Healing families with grace and faithfulness through God.


A Healing Grace Family Application

(hit send at the bottom of each section)

Child's Information

This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.

Submitted

Consent/ Release- Social Media, Print, Publicity, Printed & Electronic.

Consent/ Release*
This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.

Submitted

Financial Assistance

Have you been contacted by Children's Cancer Partners Of The Carolinas?*
Do we have your permission to forward your application to Children's Cancer Partners Of The Carolinas? (If you answered no above)
Make A Wish- A child with a critical illness who has reached the age of 2½ and is younger than 18 at the time of referral is potentially eligible for a wish. After a child is referred, Make-A-Wish® will work with the treating physician to determine the child's eligibility for a wish, i.e suffering from a progressive, degenerative or malignant condition currently placing the child's life in jeopardy. Have you applied for a Wish?
This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.

Submitted

How Else Can We Help Your Family?

This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.

Submitted

Parent Or Guardian Information

This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.

Submitted

Siblings

This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.

Submitted

Connections

Would you like us to connect you with another local family that has a child with a similar diagnosis?*
This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.

Submitted

I verify that all of the information I have submitted on this application page is true.

This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.

Submitted