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Kids Kicking Cancer

Power Peace Purpose

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a division of
Kids Kicking Cancer
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  • About
    • About Us
    • Staff Directory
    • Board of Directors
    • Employment Opportunities
  • Program
    • Locations
    • Student Registration
  • Donate
  • In The Classroom
    • A Look Into The Classroom
    • Meet The Heroes
    • Meditations
  • Events
    • Global Breath Brake® Day
    • Golf Outing & Dinner
    • Kick-A-Thon 2020
    • Pediatric Psychosocial Conference
  • News
    • Special Coverage
    • Press
    • Blog
    • Newsletters
  • Contact Us
You are here: Home / Program Registration

Student Registration

Below you will find an easy online registration form for Kids Kicking Cancer.

Please note, that we will also need the Physician’s Consent form sign by your child’s Doctor.  Usually the Hospital or Doctor’s office will be happy to fax it into us once the Doctor has completed the form.  If you contact the Kids Kicking Cancer office we are happy to send a blank Physician Consent Form to your doctors office, or alternatively, feel free to download it below and provide it to your doctor.  If you go that route, you will have the option of attaching a scan of it to your online registration.

Please plan to take around 5-10 minutes to complete this form.

Printable Registration forms:

Student Registration Form
Physician Consent Form

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You can make a difference right now in the life of a child. Help us lower the pain of some amazing little heroes.

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Kids Kicking Cancer’s mission is to ease the pain of very sick children while empowering them to heal physically, spiritually and emotionally.

27600 Northwestern Highway, Suite 220
Southfield, MI 48034 | Phone (248) 864-8238

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