Register your Child

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:

Mel Joubert
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

If you require assistance at the time of registration, please CLICK HERE to also fill in an assistance request form, which will be considered along with your New Family Registration Application.

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New Family Application Form

Child's Details

Please provide the full date of birth (DD/MM/YYYY)
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For example: 5 years, 2 months.
In order to receive support from Little Heroes Foundation, a child must be an Australian citizen.

Medical Details

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About the Child and Family

Little Heroes Foundation recognises the importance of supporting the whole family, so it is important that you provide us with this information, especially if there is an opportunity for your family to attend an event.

Primary Contact

This is only required if it is different from your residential address.

Secondary Contact

Please leave blank if same as residential or if it has already been provided in the form.

Additional Information

Please include their full name, relationship to you and the best method of contact, such as their phone number or email address.
Providing your social worker's name can make your registration process much simpler, as they can verify your claim for support, as well as help identify any other areas that we may be able to assist you with.
This can help inform our marketing and public relations strategies.


This is to help us better undertand the circumstances surrounding your child's treatment. It is also allows us to learn what is and is not supported by the Government and use this to inform future services.