Submitting my Child's Bio

We love to feature the brave children going toe to toe with cancer at Lady Cilento Children's Hospital.

Please fill in below if your child is a customer of The Bravery Box at Lady Cilento Children's Hospital. In submitting this form you are giving Bravery Box permission to display your answers and your child's image in our Bio section, on our social media and general media. We will NOT use your image or information for any other reason than to promote The Bravery Box.

My child is all kinds of Brave.

* Indicates required field

Parent / Guardian's name *

First

Last

Parent / Guardian's Email *

Parent / Guardian's phone number *

Child's Name *

Child's Diagnosis and Oncologist *

Treatment Hospital *

Child's current age *

Child's age at diagnosis *

Diagnosis Story (diagnosis, symptoms leading up to diagnosis, timeline, etc) *

Tell us something about yourself *

Best Day EVER *

When do you choose to be Brave? *

I give permission for my child's image and bio to be used in the promotion of The Bravery Box. *

Yes No

Please submit a photo by email or text to tanya@littlebigswim.com.au or 0416229694

Submit