Become an FGP Family

We are here to support families with a child in treatment for pediatric cancer living in Stafford, Spotsylvania, Caroline, King George Counties, the City of Fredericksburg, the Northern Neck, or Northern Orange County (22508, 22433, 22542, 22567, and 22960). Please fill out the form below, and we look forward to speaking with you soon.

Who is the best person to contact to set up services?

What is your prefered means of contact?

Best contact phone number

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Email address

Which locality do you reside in?

Address

City & Zipcode

Child's name

First Name

Last Name

Child's birthdate

YYYY

Child's diagnosis

Date of diagnosis

YYYY

Where is your child receiving treatment? Please include name of oncologist or contact at hospital

Do we have permission to reach out to the above mentioned on your behalf to confirm treatment?

What is expected date of treatment completion?

Do we have permission to share your name and contact information with our service providers and partners?

We will share your information with lawn service, Moms in Motion (provide assistance with the medicaid waiver, which serves as secondary insurance), cleaners, a lead volunteer, CCP sponsor, AAA, and YMCA (you will receive memberships).

How did you hear about FGP?

In consideration of Fairy Godmother Project allowing Volunteer to act as an official “Fairy Godmother Project” volunteer, Family voluntarily waives any and all rights to recovery from Fairy Godmother Project, its representatives, agents, officers, directors, shareholders, employees, insurers, attorneys, successors and assigns, for all claims, demands, damages, actions, costs, expenses, actions, causes of action, suits at law or in equity for injuries, damage, or other loss to person or property that Family and any other individual or entity claiming by or through Family, may sustain while receiving services as part of the Fairy Godmother Project.

The parties agree that electronic signatures will be permitted under the provisions of the Virginia Uniform Electronic Transactions Act, Va. Code § 59.1-479 et seq.

Any other information you'd like to share

This application does not guarantee services.

Become an FGP Family

FAIRY GODMOTHER PROJECT