Request a Superhero Visit for a child battling cancer!
REQUEST A VISIT
 
What is Your First Name? *

 
What is Your Last Name? *

 
What is Your Phone Number? *

Format: 000-000-0000
 
What is the First Name of the Child? *

 
Consent for Communications *

By submitting this Form, you consent to allow Love Your Melon to contact you for purposes relating to the Child's Visit via email, phone or other means.
     
 
Does the Child ({{answer_28561860}}) live in the United States? *

     
 
What is Your Relationship to the Child ({{answer_28561860}})? *


 
By selecting that you are an Immediate Family Member or Legal Guardian of the Child ({{answer_28561860}}), you are confirming that you will be the main contact for planning a Superhero Visit with one of our Campus Crews for the Child. Please be aware that a member of the Love Your Melon Event Coordination Team will be contacting you in order to set it up.

Please select "Yes" to confirm: *

     
 
What is {{answer_28561860}}'s Gender? *


 
What is {{answer_28561860}}'s Age? *

 
What is {{answer_28561860}}'s Favorite Color? *

 
What is the Street Address for {{answer_28561860}}'s Visit? *

Example: 301 Thomas Ave N.
 
What is the Street Address #2 for {{answer_28561860}}'s Visit? (Optional)

Example: Apt. 201
 
What is the City for {{answer_28561860}}'s Visit? *

Example: Minneapolis
 
What is the Zip Code for {{answer_28561860}}'s Visit? (5 Digit) *

Example: 55405
 
Is the Child ({{answer_28561860}}) currently an inpatient at a hospital receiving treatment or a current resident of a Ronald McDonald House or other Support Facility? *

     
 
Thank you for requesting a Superhero Visit for {{answer_28561860}}. However, due to hospital/support facility policy, we are unable to conduct this type of visit to children currently receiving treatment or staying at a support facility. But we may have a Large Donation Event at that location soon!

If the child will be leaving the hospital/support facility location soon, please let us know in the notes section below:

 
Please provide any additional notes that you would like us to know about {{answer_28561860}} or other information that would be helpful for us to plan the Visit. (Optional)

{{answer_28562336}},
Thank you for your requesting a Superhero Visit for {{answer_28561860}}. However, we cannot proceed in planning the event until we receive the contact information of an Immediate Family Member or Legal Guardian of the Child. We've just sent you an email with a link to this Form to forward on to the Child's Family! Please share it with them so that we can plan them a great visit!

Best,
The Crew
Done
{{answer_28562336}},
Thank you for your requesting a Superhero Visit for {{answer_28561860}}. However, we currently cannot carry out Visits for children and families outside of the United States. If this changes in the future, we will let you know! Thank you for your support in the fight against pediatric cancer.

Best,
The Crew
Done
{{answer_28562336}},
Thank you for your support in the fight against pediatric cancer! If you have additional questions, please email events@loveyourmelon.com!

Best,
The Crew
Done
{{answer_28562336}},
Thank you for your requesting a Superhero Visit for {{answer_28561860}}. A Member of the Love Your Melon Event Coordination Team will be contacting you soon to plan the Visit!

Best,
The Crew
Done