Please fill out the follow-up questionnaire below.

Follow-Up Questionnaire

You may have nominated your own family or someone else who recognized you as a deserving family may have nominated you. Either way, we’re happy you’re here! Explore our website to learn more about us if you aren’t already familiar with our mission. Please fill out the questionnaire below in order to help us when planning future Escapes.

Please be aware that details of our vacations (e.g., location, dates, activities) are currently decided on a one-off basis and are determined by our organization personnel. If a given Escape we’ve planned seems to be a good fit, we will reach out with those details leading up to an Escape should your family be chosen.

  • 1. Publicity Media
    2. Treatment Services
    3. Release Hold Harmless
    4. Medical Personal Info