Survey - Share your story - Children's Hospital Foundation of Manitoba

Share your story

Thank you for your willingness to share your child’s health story. Our team at the Foundation feels honoured to learn more about the children we support. Please fill out and submit the form below and our Foundation Family coordinator will follow up with you.

Parent/Guardian Name:

*

Name:

First Required	Last Required

*

Email: Required

Phone Number:

Yes, I would like to receive email from Children's Hospital Foundation of Manitoba

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Question - Required - Relationship to the child:

Child's Name:

*

Name:

First Required	Last Required

Date of Birth:

If you respond and have not already registered, you will receive periodic updates and communications from Children's Hospital Foundation of Manitoba.

*

Question - Required - What city/town/area are you currently living in?

*

Question - Required - Please share what brought you and your child to Children's Hospital

(Maximum response 255 chars, approx. 5 rows of text)

*

Question - Required - What was your child diagnosed with?

Question - Not Required - Share your story below: