Patient/Patient Family Story

COMPLETE THIS FORM SO THAT WE CAN CONTACT YOU WITH UPCOMING DREAM DAY FOUNDATION EVENT ANNOUNCEMENTS

This form is not a registration for an event, but provides us a way to contact you when registration for events is open.
Please provide accurate email and mailing addresses so that we can reach you when registration opens

Storytelling is the most compelling way for a foundation to raise awareness and funds. We understand that everyone has their own, individual Dream Day Story and we are interested in hearing yours! We want to make sure you hear from us and that you can get involved if/when/where you want!

We ask if you have a few minutes, if you can complete these questions so we can get to know your individual patient and family story! Please complete as many fields as you feel comfortable answering.

Note: Any field with a star/asterisk is a required field. Most fields are optional, but we'd love to hear from you on everything!

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Here's why we are asking:
Event Registration - Dream Day Foundation offers several events for St. Jude families throughout the year, including Fishin' Galore, Camp Care, and an annual family Christmas party. We need your up to date contact information so we can ensure you receive notifications when registration for events is open.
Patient Information - Aggregated information about the patient population who attend our Fishin' Galore program will be invaluable to our grant writing and prospective donor outreach efforts. We assure you that any information provided outside of the organization will only be linked to a patient first name, unless specific permission is granted. (Example: Tiffany was diagnosed with leukemia at age 7 and completed her last treatment at age 10. She continues to attend our Fishin' Galore event with her family. Her attendance encourages other families still seeking treatment.)
Previous Fishin' Galore Info - Our foundation has evolved and grown over the past 30 years and in doing so we've upgraded our system (a few times). We encourage you to let us know about your past Fishin' Galore experiences.
Engagement - Here is where we really want to hear from you! We have several speaking opportunities throughout the year including St. Jude Dream Home Giveaways, fundraising events and presentations made to groups who are encouraged to donate to Dream Day Foundation. If you are willing, we'd forever be grateful to you for speaking about your St. Jude experience and/or your experiences with Dream Day events such as Fishin' Galore and Camp Care! If you are not a public speaker, maybe you'd prefer to leave a written testimonial we could reference in print material, on social media or during these presentations. Any testimonial will be referenced by first name only, unless specific permission is granted. (Example: When we go to Fishin’ Galore and all the events Dream Day has and to be a part of that Dream Day Family, it reminds us to have life. We have hope at St. Jude and we also need to have life. *Patsy, Mother of St. Jude patient survivor)

Your Contact Information

First Name *

Last Name *

Email *

Address Line 1 *

Address Line 2

Phone *

City *

State *

Zip *

Professional Credentials

OTHER professional credentials The maximum length for the field OTHER professional credentials is 500 characters.

Patient Information

Patient Name * The field Patient Name is required.

Patient Age at Diagnosis * The numeric field Patient Age at Diagnosis is required.

Patient Diagnosis * The field Patient Diagnosis is required.

Patient Age at Last Treatment * The numeric field Patient Age at Last Treatment is required.

Patient Current Treatment Status * The field Patient Current Treatment Status is required.

Patient DOB * The date field Patient DOB is required.

Your relationship to patient * The field Your relationship to patient is required.

OTHER relationship The maximum length for the field OTHER relationship is 500 characters.

First language * The field First language is required.

OTHER language: The maximum length for the field OTHER language: is 500 characters.

Exciting achievements or milestones? The maximum length for the field Exciting achievements or milestones? is 5000 characters.

Fishin' Galore Information

For the question "Relationship to other Fishin' Galore attendee?" Please be specific and indicate if you are related to a Board Member, other St. Jude family or long-time volunteer.

What years have you attended Fishin' Galore? * The field What years have you attended Fishin' Galore? is required.

1How did you hear about Dream Day/Fishin' Galore? * The field 1How did you hear about Dream Day/Fishin' Galore? is required.

Relationship to other Fishin' Galore attendee? The maximum length for the field Relationship to other Fishin' Galore attendee? is 500 characters.

Favorite part of Fishin' Galore The maximum length for the field Favorite part of Fishin' Galore is 5000 characters.

Engagement

Workplace Giving is an easy way to make tax-deductible donations to Dream Day Foundation taken directly out of your paycheck. Typically Dream Day Foundation would discuss this opportunity with your Human Resources or Management to coordinate logistics, make a presentation to all employees and seek pledges from each individual to be fulfilled through paycheck deductions over a one year period. The pledges could be renewed yearly.

Workplace Fundraiser is any type of fundraiser done with your coworkers in a single office or across your company's network. This could be a $5 Jeans for Dreams day, a unique tshirt sales fundraiser, scavenger hunt to raise awareness for your company/Dream Day Foundation, a new & fun fundraiser we develop together!
You may choose more than one option for the dropdown menus labeled None Selected to accurately indicate your response.

Previous Dream Day Foundation Participation

Do you want to hear about our fundraisers/events?

Would you or someone in your family be willing to do a speaking engagement?

When do you want to hear from us?

Would you consider requesting a Jeans for Dreams day at your school?

What is the name of the school for Jeans for Dreams day? The maximum length for the field What is the name of the school for Jeans for Dreams day? is 500 characters.

Want to start Workplace Giving or Fundraiser?

Employer The maximum length for the field Employer is 500 characters.

Dream Day/Fishin Galore Testimonial The maximum length for the field Dream Day/Fishin Galore Testimonial is 5000 characters.