An organization dedicated to bringing smiles to the faces of children facing cancer
who are treated at McMaster Children’s Hospital
To become a member of Help A Child Smile, the following criteria must be met:
1.child diagnosed with cancer
2.treatment is provided by McMaster Children’s Hospital

Your registration will be validated by the hospital
Child's Surname:
Child's Given Name:
Residential Address:
Street:
City:
Province: Ontario
Postal Code:
Home Phone:
Business Phone: .ext
Cell Phone:
E-mail:
Parent's First Name
Parent's Last Name
Parents Address (if separate residences, please provide both)
Street:
City:
Province:
Postal Code:
Names of Cancer Child's siblings:
First Name
Last Name
Birthdate
First Name
Last Name
Birthdate