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Toggle Menu
Who We Are
News & Events
Mission & History
Our Team
Board of Directors
Emily’s House Family Advisory Council
Reports & Financials
Contact Us
What We Do
Calendar
Videos
Emily’s House Children’s Hospice
EH Testimonials
Visiting Hospice
PAC Testimonials
EH at Home
IMPACT/Perinatal
HIV/AIDS Supports
Grief Support
Spiritual Care
Volunteer Support
Compassionate Communities
What We Do (French)
Client Resources
How to Access Care (PAC)
How to Access Care (EH)
Client’s Bill of Rights
Community Resources
Volunteers
Volunteer Information
Volunteer Training
Already a volunteer?
Youth Advisory Council (YAC)
Volunteer Stories
Ways to Give
How to Donate
Donate Goods
Fundraising Events
Tribute / Memorial Gift
Planned Giving
Gifts of Securities
Our Donors and Supporters
Charitable Tax Receipts
Jobs & Placements
Emily’s House Application Form
Child's Name
(Required)
Date of Birth
(Required)
Health Card Number
(Required)
Your Name
(Required)
Your Relationship to the Child
(Required)
Your Phone Number
(Required)
Your Email Address
(Required)
Summary of child's medical condition (include all diagnoses)
(Required)
Does your child require any special equipment (feeding pump, ventilator, oxygen, etc)?
Does your child qualify for Enhanced Respite through CCAC?
(Required)
How did you hear about Emily's House?