Registration

Lily, a 2-year old resilient, happy, and Tumble-Bee loving Rockland County girl, is courageously battling Diffuse Intrinsic Pontine Glioma (DIPG), a rare and aggressive pediatric brain cancer. Lily attends classes at Tumble-Bee, and her family is very much a part of the Tumble-Bee family. We are coming together to support our family member in this difficult time. Although Lily has been given 6-9 months to live, in the midst of this painful reality, she continues to defy expectations with her laughter and resilience that shine brighter than her dark prognosis. The financial burden of medical treatments, experimental therapies, and, unfortunately, end of life care is overwhelming for Lily's family. Thank you for opening your hearts to Lily's story, and for standing with Lily's family as they fight against DIPG! Please complete this form to sponsor a Cartwheeler! (Please put N/A for Emergency Contact)
Event:
Start Date/Time: End Date/Time:
Fee per Family: Room:
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Family Information
First Name:* Last Name: *
Type*
Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info*
 
 
 
Questions/Options:
Name of the participant you are sponsoring (If sponsoring someone)
Would you like to donate per cartwheel, or a flat amount?*
How much would you like to donate?
 
Additional Information:
 
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Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
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eCheck/Bank Draft:
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Your Account Name: (Your name on your bank statement)
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