Donate To Leukemia Foundation To Care For Kids Suffering With Cancer

"What children with cancer and their loved ones always need to remember is that hope can spread faster than cancer. Hope is real." — Barbara Reid, CLF Founder "Hope is like the sun, which, as we journey towards it, casts the shadow of our burdens behind us." — Samuel Smiles "Hope smiles on the beginning of the year to come, whispering that it will be happier." — Alfred Lord Tennyson

To request a free Hugs u Wear, just view the choices on our website or in our brochure. Then ask your Child Life Specialist or Social Worker to fill out an order form and send it to us. Remember, a free Hugs u Wear can only be placed by your social worker.

Choose from the following hairstyles, colors and caps.

Hair Texture:	Hair Color:	Cap Color:

Our hair products are available in sizes small, medium and large. Please measure your head accurately using a cloth ruler. Wrap ruler entirely around the widest part of the head, over your eyebrows. Order hair product according to the following measurements: Head Size: *All hair length is set to 12" which you can cut to a shorter length.

* You must first enter a valid Authorization Code to process the order. This authorization code will be validated after this form is completed and submitted.
* All information provided to CLF is kept completely confidential in accordance with HIPPA regulations.

Authorization Code:

Please note - Hugs will only be shipped to the hospitals and treatment centers. Residential deliveries are no longer being offered.

Hospital Information

P.O. Number	*Child's Age

*Child's First Name	*Child's Last Name

*Hospital Name

*Hospital Street Address (No P.O. Box)

*City	State Zip

*Social Worker

E-mail

*Telephone	Fax

*Child Diagnosis

(*) Denotes Required Fields

Office Use Only:
Administration

Please allow for 2-3 weeks for delivery by UPS.

Download PDF Order Form To order, view the choices on our website or in our brochure.

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