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Trillium Childhood Cancer Support Center Adult Camper Health Record 2016 Please Print (in effect for all programs in 2016) Name: (last) (first) Birth Date: (mm/dd/YYY) (middle) Sex: Male Female For
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How to fill out Trillium Childhood Cancer Support:

01
Start by obtaining the Trillium Childhood Cancer Support form from the official website or requesting it from the organization.
02
Carefully read the instructions provided in the form to understand the eligibility criteria and required information.
03
Begin by entering your personal details such as your full name, address, contact information, and any other relevant identification details.
04
Provide information about the child who is battling cancer, including their name, age, and the type of cancer they have been diagnosed with.
05
Fill in details about the child's medical history, such as previous treatments, medications, and any ongoing medical procedures.
06
Include information about the child's healthcare provider, including the name of the doctor or hospital overseeing their treatment.
07
Provide details of any financial assistance programs or insurance coverage that the child currently receives.
08
Indicate the specific type of support or assistance that you are seeking from Trillium Childhood Cancer Support. This could include financial aid, emotional support, educational resources, or any other specific needs.
09
If applicable, attach any supporting documents that may be required to verify the information provided, such as medical records, financial statements, or referral letters.
10
Review the completed form carefully to ensure all information is accurate and complete before submitting it as per the instructions provided.

Who needs Trillium Childhood Cancer Support?

01
Families and caregivers with a child diagnosed with cancer who require financial assistance, emotional support, and access to essential resources during the child's treatment journey.
02
Children battling cancer who are in need of additional support, whether it be for medical expenses, counseling services, specialized education, or other forms of assistance.
03
Healthcare providers who identify children with cancer that would benefit from the services provided by Trillium Childhood Cancer Support and require assistance in connecting them with the organization.

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