COMMUNITY OF CARE FAMILY APPLICATION

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The Lighthouse Family Retreat Community of Care (CoC) Program will provide support to families living through childhood cancer, through meals, prayer, and other acts of kindness. Lighthouse has partnered with churches and organizations in communities all across the country to recruit volunteers who will come alongside you and your family in this fight and serve you in ways that will help you find rest, joy, restoration, and hope beyond a cure.

Participation in the Community of Care Program is on a first-come, first-served basis, and is in direct correlation to the number of volunteer families serving in your community. In order to participate in the Community of Care Program, the following criteria must be met for eligibility.

*Qualifying families must have a child who is 18 years of age or younger, who is currently being treated for cancer. 


*Each child on treatment for cancer must have the verification of treatment form completed by their social worker to participate in the program.


*Only immediate family members living at home will be supported in the program.

Primary Parent/Legal Guardian Information


Child with Cancer Information



Second Adult?
Adult 2 Information


The CoC Program supports siblings under the age of 21 who are currently living at home.
Siblings?
Please complete the Sibling Information section below for each sibling living in the home.
Sibling Information


To add another sibling, click on "Add another response" above.
Family Information



Each Family Members Favorites










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Contact Information