Refer A Child

Who is eligible?

Participants in BounceBack Kids are children who have a serious medical condition, range in age from 3-21 and have a doctor’s permission to participate in physical activities. Our participants have cancer, sickle cell anemia, cystic fibrosis, diabetes, asthma and other chronic illnesses.

Watch a video about BounceBack Kids

Who can refer a child?

Anyone can refer a child to BounceBack Kids. People who refer to BounceBack Kids include

• teachers, nurses, social workers and/or other school personnel
• doctors, nurses, child life specialists and/or other hospital personnel
• pediatricians, family medical doctors, nurses and/or other private practice personnel
• parents and/or other family members of children with serious medical illnesses

How do I refer a child?

If you are a referral partner, send us the child’s and parent’s name and we’ll contact them. If you are a parent or guardian of a child, simply fill in the information and we’ll contact you. Alternately, print and send in these forms:

Participant Form

Sibling Form

Medical Permission

Do you have an upcoming meeting or event and would like us to come and talk about BounceBack Kids? Would you like more information in person? Send us an email at info@bouncebackkids and we’ll arrange to come out.