Disclaimer & Acceptance:
I the above mentioned individual do hereby agree that all information in this form is true to best of my knowledge and is for use by The Brave Kids Org. only. The Brave Kids .org is authorised and allowed to use the same for internal research and personal only and to act as a communication link between The Brave Kids & their families/friends to find cure, update news, information seminars, educational programs, recreational activities / invitations and to form a group. Any other purpose which helps to improve better quality of life and control / manage this medical condition. I believe this information will be kept private and will not be used for any other commercial business purpose other than donation and volunteer help related campaigns as per The Brave Kids.og policy. By submitting this form I acknowledge /accept and agree to all above
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Please note this action will delete all information filled above in the form
Please select your level of membership:
This is a FREE membership form for individuals involved in this Medical Condition directly or indirectly.
Please allow 48 business hours for The Brave Kids.org to review and approve your request.
Please read carefully and answer all questions. In complete forms will not be processed.
This membership is offered to all Brave Kids, Brave Children & Brave Teens:
Brave members under 10 may get help from their family members to submit this form.
Birth Year of Brave Kid/Child/Teen:
Year diagnosed or number of years in condition:
Brave members Full Name for our record only:
This exact name will be printed on membership Card.
Country of Current Resident:
Will like to have Membership Card :
Complete residential address with street number
Street name, City name, Province/state postal code if any and country.
Tel: Number with country and city code:
Valid & Active email address:
Please provide brief history about your condition like how you get it, your experience and situation if any you have been through or any advise or tip you will like to share with other brave kids and their fanilies.
This information may help others to better control or manage their condition / life and may be published on our web as per your instructions. Please type NA if you dont want now..
Any special instructions:
Please selct one of these
Please selct one of these
Please describe in this box briefly if you have any other medical condition or complication.
Please type NA if none.
Have you ever been hospitalized:
Who is providing you care Now:
Who is helpping in your treatment Now:
How Did you hear about brave kids org:
Please type in name of person filling up this form if other than the applicant it self:
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