WELCOME TO CLUBNEGU
The Jessie Rees Foundation’s ClubNEGU is a free encouragement program for all Courageous Kids fighting cancer and their families. Once you sign up, boosts of joy will be delivered straight to your doorstep over the next 12-18 months! These gifts are delivered to bring your family smiles, help you create priceless memories, and encourage you all to Never Ever Give Up. You are never alone in your journey!
COURAGEOUS CHILD
Child’s First Name
Birthdate (MM/DD/YY) Age
Child’s Cancer Type
Treatment Status
Affiliated Hospital
T-shirt Size (circle) YS YM Child’s Favorite Things
(colors, music, toys, games, tv/movies, activities)
Child’s Support Page
(if applicable – Facebook, Instagram, CaringBridge)
Child’s Home Address
Child’s City
Is this a military address?
Child’s Last Name
Gender (boy/girl)
YL/AS
□ Child’s Sta□te YES
AM AL
Child’s Zip Code
COURAGEOUS PARENT(S)/LEGAL GUARDIAN(S)
NO
Other (list relationship)
Mom T-shirt Size
Dad T-shirt size
Guardian T-shirt size
Your First Name
Your Relationship to Child (circle)
Your Email (required)
Your Phone
Mother
Father
Your Last Name
Legal Guardian
S M L XL XXL XXXL
M L XL XXL XXXL
S M L XL XXL XXXL
COURAGEOUS SIBLINGS (please complete for each sibling under the age of 18. Please feel free to use the back of this form if needed)
Sibling #1
First Name
Birthdate
Sibling #2
First Name
Birthdate
Sibling #3
First Name
Birthdate
Sibling #4
First Name
Birthdate
Parent Signature
Gender (boy/girl)
Gender (boy/girl)
Gender (boy/girl)
Gender (boy/girl)
Last Name
Last Name
Last Name
Last Name
T-shirt Size
T-shirt Size
T-shirt Size
T-shirt Size
Date
YS YM
YS YM
YS YM
YS YM
YL/AS AM AL
YL/AS AM AL
YL/AS AM AL
YL/AS AM AL
ClubNEGU is available in the USA/Canada. Learn more about the Jessie Rees Foundation, inspired by 12-year-old Jessica Joy Rees during her own fight with cancer, at www.negu.org.