Child's Case Upload for Helpster

Use this form to send information regarding children's cases suitable for the Helpster Program

Country *

Volunteer's name *

Child's First Name *

Child's Last name *

Child's Age *

Hospital (if known)

Where the child lives?

Health Issue *

Child's story *

Parents and their contacts *

Cost of treatment (if known)

Volunteer's Comment

Is it an Urgent case?

Parents signed both consents