Enriching the lives of children battling serious illness & injury...

Family Giving

Because financial resources can be severely impacted during treatment, Hope’s Haven maintains a program of family gifting. With needs identified by your social worker, Hope’s Haven delivers gift cards for gas, food and other direct bill payment essentials, along with presents for the child who is sick, as well as the siblings who may be equally in need of a smile.

Family Giving Nomination Form:

Hope’s Haven is a non-profit charity dependent on grants and community donations. We collect data on our beneficiaries for the purposes of grant reporting.

Important notice:

You will not be discriminated against or denied aid because of your race, religion, color, national origin, sex or political affiliation. The information you provide to us will be held in confidence and used only in appropriate ways consistent with the reason for which it was provided. Additional information may be requested.

    Referring Party:

  • Name:
  • Phone:
  • Email:
  • Relationship:
  •  

    Patient Information:

  • First Name:
  • Last Name:
  • Age:
  • Address:
  • City:
  • Zip Code:
  • Phone:
  • Email:
  • Mother/Father/Family Contact / Name:
  • Language Preference:
  • Hospital:
  • Diagnosis:
  • Date of Diagnosis:
  • Attending Physician:
  • Social Worker:
  •  

    Financial Assistance:

  • Household Income:
  • Is the Parent/Guardian on unpaid leave:
  • How many people are in the household:
  • Ethnicity(Optional):
    • VIP Events:

    • Would your Child be interested in being apart of a VIP event where he/she will be invited to special events such as Dodger Games, Naval Base Visits, or Holiday Parties?: