This registration form is to be completed by a parent or guardian.
Every child is different and family circumstances can vary drastically. To help Little Heroes Foundation make informed decisions on the support requirements of families with seriously ill children, please ensure that you fill in all sections of this form where possible.
If you have any questions about your application, how we can help your family, or would like to have a section of the form explained to you, please contact the Little Heroes Care Program Manager at:
Phone: (08) 7099 3628
By submitting this form, you are agreeing to have your details kept in a confidential database for the purposes of Little Heroes Care Program Management with Little Heroes Foundation Incorporated.
Please allow 2 - 3 business days for your applications to be processed. If you have an urgent matter, please call our office on (08) 7099 3628
>>Download a paper version of this form here<<
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