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Join the Riley’s Army family here

Join the Riley’s Army family

If your child has been diagnosed with cancer, we are here for you.  Here are some important things for you to know about becoming a Riley’s Army family:

We welcome you and are committed to supporting you every step of the way!  Please fill out the form below so that we can add you to the Riley’s Army family.

  • Parent(s) Name

  • Address

  • Contact Information

  • Please enter your date(s) of birth. Your year of birth is of course optional.
  • Child's Information

    Please provide your child's name, date of birth, diagnosis and date of diagnosis. Please provide any additional information or special interests you feel would help us get to know your child.
  • Siblings

    Please list siblings and their dates of birth. Also, list any special interests of the siblings.
  • Possible Areas of Help

    Riley's Army wants to help you in any way you need. Please list any areas that you would like assistance with, now or in the future.

  • Special Precauation

    Please list any special precautions we should know about your family such as food allergies.
  • Registration Agreement

    All information provided is for Riley's Army use only. I voluntarily accept help and support from Riley's Army. I am under no obligation to accept services and can decline services at any time. I understand services are provided free of charge and no promise of services or financial support has been made by Riley's Army. I understand services are provided by volunteers and understand the limitations of such services. I agree to provide feedback and report any concerns with services provided by Riley's Army to Riley's Army. I understand Riley's Army reserves the right to decline services at any time and that there is an annual limit to financial assistance. Riley's Army does not discriminate based on race, gender, religion or financial status.
  • This field is for validation purposes and should be left unchanged.