Refer A Child
Who is eligible?
Participants in BounceBack Kids are children who have a serious medical condition, range in age from 3-21 and have a doctor’s permission to participate in physical activities. Our participants have cancer, sickle cell anemia, cystic fibrosis, diabetes, asthma and other chronic illnesses.
Who can refer a child?
Anyone can refer a child to BounceBack Kids. People who refer to BounceBack Kids include:
- Teachers, nurses, social workers and/or other school personnel.
- Doctors, nurses, child life specialists and/or other hospital personnel.
- Pediatricians, family medical doctors, nurses and/or other private practice personnel.
- Parents and/or other family members of children with serious medical illnesses.
How do I refer a child?
Simply download, complete the form and either email, fax or mail them to us. Once we receive the forms, we’ll contact you.
Participant Form This form includes general contact information, including emergency contacts, home address and age of child.
Sibling Form If there are any siblings that would like to participate, we need a form for our records.
Medical Form Your medical provider will need to complete the medical form.
Do you have an upcoming meeting or event and would like us to come and talk about BounceBack Kids? Would you like more information in person?
Send us an email at info@bouncebackkids.org and we’ll arrange a time to talk to you.
It's a time to be with kids who are like you and go through some of the same things you do. IT is a time to forget about your illness and have fun.
- Participant
