Starlight Family Registration

Thank you for visiting our family registration page. Our mission is to partner with experts to improve the life and health of kids and families around the world. We invite you to join us in our mission. By registering here, you will enable Starlight to:

  • Share with you stories and information about families who are walking a path similar to yours and about health care partners focused on your needs.
  • Represent the needs of kids and families around the world to donors, corporate sponsors and health care providers who are committed to providing meaningful support through Starlight’s array of point-of-care programs.
  • Keep you informed of program opportunities and advancements as Starlight Children's Foundation continues to expand our support of kids and families from hospital to home.
  • Invite your family members, ages 13 to 20, to join the Starbright World online community, the first global social network for teens with chronic illness and teen siblings of a child of any age with a chronic illness, where they can share their experiences, interests, ideas, games and entertainment in a safe, adult-monitored community.

 

We look forward to hearing from you and welcoming you to the Starlight family! If you need assistance registering or have questions, please contact Rebecca Aune, Hospital & Family Program Manager.

Starlight is committed to protecting the privacy of our families, volunteers, donors, and employees. All personal information collected is used to deliver services and information to those participating in our programs. This data remains confidential and will never be sold or disclosed to third parties.

Child 1
Date of Birth *
E.g., Sep 16 2014
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Date Diagnosed *
E.g., Sep 16 2014
Date of Last Treatment *
E.g., Sep 16 2014
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Child 2
Date of Birth
E.g., Sep 16 2014
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Files must be less than 8 MB.
Allowed file types: png gif jpg jpeg.
Date Diagnosed
E.g., Sep 16 2014
Date of Last Treatment
E.g., Sep 16 2014
Child 3
Date of Birth
E.g., Sep 16 2014
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Files must be less than 8 MB.
Allowed file types: png gif jpg jpeg.
Date Diagnosed
E.g., Sep 16 2014
Date of Last Treatment
E.g., Sep 16 2014
Child 4
Date of Birth
E.g., Sep 16 2014
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Files must be less than 8 MB.
Allowed file types: png gif jpg jpeg.
Date Diagnosed
E.g., Sep 16 2014
Date of Last Treatment
E.g., Sep 16 2014
Child 5
Date of Birth
E.g., Sep 16 2014
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Allowed file types: png gif jpg jpeg.
Date Diagnosed
E.g., Sep 16 2014
Date of Last Treatment
E.g., Sep 16 2014
Child 6
Date of Birth
E.g., Sep 16 2014
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Files must be less than 8 MB.
Allowed file types: png gif jpg jpeg.
Date Diagnosed
E.g., Sep 16 2014
Date of Last Treatment
E.g., Sep 16 2014
Child 7
Date of Birth
E.g., Sep 16 2014
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Allowed file types: png gif jpg jpeg.
Date Diagnosed
E.g., Sep 16 2014
Date of Last Treatment
E.g., Sep 16 2014
Child 8
Date of Birth
E.g., Sep 16 2014
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Files must be less than 8 MB.
Allowed file types: png gif jpg jpeg.
Date Diagnosed
E.g., Sep 16 2014
Date of Last Treatment
E.g., Sep 16 2014
Child 9
Date of Birth
E.g., Sep 16 2014
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Allowed file types: png gif jpg jpeg.
Date Diagnosed
E.g., Sep 16 2014
Date of Last Treatment
E.g., Sep 16 2014
Child 10
Date of Birth
E.g., Sep 16 2014
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Allowed file types: png gif jpg jpeg.
Date Diagnosed
E.g., Sep 16 2014
Date of Last Treatment
E.g., Sep 16 2014
Child 11
Date of Birth
E.g., Sep 16 2014
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Files must be less than 8 MB.
Allowed file types: png gif jpg jpeg.
Date Diagnosed
E.g., Sep 16 2014
Date of Last Treatment
E.g., Sep 16 2014
Child 12
Date of Birth
E.g., Sep 16 2014
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Files must be less than 8 MB.
Allowed file types: png gif jpg jpeg.
Date Diagnosed
E.g., Sep 16 2014
Date of Last Treatment
E.g., Sep 16 2014
Parent/Guardian 1
Parent/Guardian 2
Parent/Guardian 3
Parent/Guardian 4
Parent/Guardian 5
Parent/Guardian 6
Household Information
Address
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