Warrior Family & Comfycozys Onboarding

For Comfycozy applications, make sure you select “yes” for the question “Will you be requesting a comfycozy?”

If you have any questions, feel free to reach out from your Messages App within the portal 🙂 

Parent/Caregiver name
*Please ensure this email matches your account email. If you are unsure, you can check your settings on the bottom left.
Parent/Caregiver Address
Need Second Parent or caregiver info?

Warrior Info

Part 1/2. The second part to this section is completed after this form is submitted*
Warrior/Patient's Name
Will you be requesting a ComfyCozy?
Comfort & Care Counseling | https://amandahope.org/comfort-care-counseling/
Are You Interested in Our Mentoring or Wellness Services?
Note - A team member may follow up with more information*
If you have one.
Selected Value: 0
Number of Siblings
By confirming yes, I give permission to be contacted about Amanda Hope Rainbow Angels by SMS text at my residential or cellular number, dialed manually or by autodialer (consent to be contacted is not a condition to participate). I consent to be contacted even if my phone number appears on an Amanda Hope Rainbow Angels Do Not Call List, a State or National Do Not Call Registry, or any other Do Not Contact List.
By confirming yes, I give permission to be contacted about Amanda Hope Rainbow Angels by email at my provided email address (consent to be contacted is not a condition to participate). I consent to be contacted even if my email address appears on an Amanda Hope Rainbow Angels Do Not Email List or any other Do Not Contact List.

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