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Medical Referral Application for Guest Families

This form is intended to be completed by medical professionals (Social Workers, Child Life Specialist, Cancer Navigators, etc.). Additionally, You, or another medical professional, must have talked directly to the family about Thumbs Up Mission and they have expressed interest in attending a retreat as well as consent for us to contact them directly. 

To qualify for our retreat:

  • The family must have a cancer patient in the immediate family (parent, legal guardian, or child) and the cancer patient must have received treatment within the last 18 months.

  • The family must have at least one child between the ages of 5 and 18 living in the home.

  • The family cannot have attended a Thumbs Up Mission retreat before.

Thanks for submitting! We will be in touch shortly!

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