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In of
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Who can we contact for in case of emergency?

's emergency contact is my , whose name is . Their email address is email , and phone number (including area code) is .

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Thanks . You’re all done, we’ll be in touch soon!

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We’re sorry for your loss. Please tell us a little about them.

My sibling, , was diagnosed with . They passed away in of .

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Tell us about your sibling living with, or who survived cancer.

My sibling, ,
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I a parent or guardian with cancer.

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We’re sorry for your loss. Please tell us a little about them.

, was diagnosed with . They passed away in of .

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My , was diagnosed with .
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I’d like to refer .
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lives in
.
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is currently .
Their NHI number (if you know it) is .

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In of was
diagnosed with .
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Does have brothers or sisters?

has brothers and sisters.

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's brother or sister

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's parents or guardian says it’s for CanTeen to contact them.

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Please let us know how we can contact .

's email address is . Their phone number (including area code) is , and their postal address is .

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. Let’s get to know you!

Nice to meet you . Tell us a bit about yourself!

CanTeen is for young people who are 13 years old or over. We’d love to have you when you turn 13! For now, we’d recommend you get in touch with The Child Cancer Foundation.

CanTeen is for people 13-24 years old. But there are lots of other support options for adults. For more info or to get in touch please email info@canteen.org.nz

Where do you live in New Zealand?

What’s your current situation?

Tell us about your diagnosis.

Do you have brothers or sisters?

Can you tell us more about your sibling?

Due to their age, are also eligible to join CanTeen.

Because you’re under 18, we need to know it’s OK to contact you.

Oops. You’ll need permission from a parent or guardian. Please come back to this form when you’re ready.

Thanks . Is there anything else you’d like to tell us about yourself? For example, if you have any visual impairments or medical implants?

Please let us know how we can get in touch with you.

How would you like us to contact you?

Who can we contact in case of an emergency?

Who can we contact for in case of emergency?

Thanks . You’re all done, we’ll be in touch soon!

What’s your family relationship with cancer?

Do you have other brothers or sisters?

Can you tell us more about your other sibling?

We’re sorry for your loss. Please tell us a little about them.

Tell us about your sibling living with, or who survived cancer.

What’s your family relationship with cancer?

We’re sorry for your loss. Please tell us a little about them.

Tell us about your parent living with, or who survived cancer.

Nice to meet you . Who would you like to refer to CanTeen?

Where does live in New Zealand?

What is 's current situation?

Tell us about 's diagnosis.

Does have brothers or sisters?

Can you tell us more about 's sibling (please fill in as much as you can)?

Because is under 18, we need to know it’s OK to contact them.

Thanks . Is there anything else you’d like to tell us about ? For example, if you have any visual impairments or medical implants?

Please let us know how we can contact .

How would prefer to be contacted?

Oops!

3000 young people are growing up in the shadow of cancer.

We Need Donations

30 years of CanTeen our journey so far

Latest News

Want to give back?

Subscribe to CanTeen

Volunteer

Donate Today

CanTeen is for young people who are 13 years old or over.
We’d love to have you when you turn 13!
For now, we’d recommend you get in touch with The Child Cancer Foundation.

CanTeen is for people 13-24 years old.
But there are lots of other support options for adults.
For more info or to get in touch please email info@canteen.org.nz