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Need assistance?

Need assistance while your child is in treatment? 
We are here to help in any way we can!
Please take a moment to fill out the form below.


*Does your child have Neuroblastoma?
Yes
No
*When was your child diagnosed?
0 - 3 months ago
3 - 6 months ago
6 - 9 months ago
9 - 12 months ago
a year or more ago


*May we contact the hospital for verification?
Yes
No

*What type of assistance do you need?
Financial
Emotional
Information
Other


Thank you for taking the time to fill out our application. 
We will do our best to assist each and every family that applies.

Please Note: Assistance is based on our ability to generate the funds to donate, at this time we can only assist those whose child has been diagnosed with NB.

**We are currently in the process of moving our website from a .com to a .org - IF you have filled out our form for assistance and have not heard from us within a week, please drop us an email (daxtonsfish@yahoo.com) letting us know that you have submitted a request or you can fill out our contact us form on our new website www.daxtonsfish.org - thank you for your patience while we get moved!**

Be sure to click the SUBMIT button when finished, Thank you!