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Apple a Day Program Application

Helping kids stay connected while fighting cancer.
    Please note: while we are always looking for ways to expand our markets, currently only families living in Orlando, Tampa, or NYC will qualify.
  • Although we are considering ways to grow and serve other kids, we currently only work with kids with a pediatric cancer diagnosis. Our love goes out to ALL families fighting disease though!
  • Child Life Specialist / Social Worker

  • Further Information

  • By signing below, I hereby release the rights of this information to be used by Apple A Day Program at any time they may deem it helpful to use in their efforts to raise more money for children and families battling cancer. I understand that my story may be shared via a number of different formats with the public, including written, video, audio, or photographic.
  • By initialing below, I hereby release medical information about my child to Apple A Day, specifically limited to determining eligibility for an iPad. The aforementioned treating hospital representative and/or Children’s Cancer Center Representative is now given my permission to discuss this information about my child with a designated volunteer of Apple A Day.