Children's Specialized Hospital

Advokids

We are always looking for families who can help us share the amazing stories at our hospital. When we talk with volunteers, donors, or sponsors, they want to hear first-hand from our families, who can really explain what a difference our hospital makes. If you and your family have a great story, or have had a great experience at our hospital and would be willing to share it with others, we invite you to submit your information below. You and your family could be our next advocates - and AdvoKids!

*Patient's Name:

*Date of Birth:

*Grade in School:

*Parent/Guardian Name(s):

*Street Address:

*City:

*State:

*Zip:

*Daytime Phone Number:

*Email:

*Child's Treated Condition(Diagnosis):

*Site Child was Treated at:(Choose multiple
Centers if applicable)

Bayonne Hamilton Roselle Park
Clifton Mountainside Toms River - Stevens Road
Fanwood New Brunswick Toms River - Lakehurst Road

Tell us about your child's story and your experience at Children's Specialized Hospital:

Did you have a special doctor, nurse, or therapist the child worked with? If so please tell us here:

*Is the child still a patient at Children's Specialized?

YesNo

*If no, please list dates of treatment:(mm/dd/yyyy)

From To

*We would be willing to share our story in the following ways: (check all that apply)

Participate in interviews for radio, TV, newspapers
Speak at special events in my area
Volunteer at special events in my area
Share my picture and story in hospital publications or website
Share my story at Hospital or sponsor meetings and events
I would like to receive the Hospital and Foundation newsletter

Giving