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Our vision is to distribute I.C.O.N. shirts to any warrior hero who requires port access.

Through the generosity of many friends of Stay Strong Foundation, the I.C.O.N. shirts are donated to pediatric cancer patients free of charge to help ease the anxiety of treatment days.

Please help us by sharing our Facebook or Instagram or by e-mailing us a testimonial if our shirt has made a difference. Your support will help us to reach as many warrior heroes as possible.

ICON Order Form

Parent/Guardian's Name

First Name

Last Name

Name

Warrior's Name

First Name

Last Name

Parent/Guardian's Phone

In case we have questions!

(###)

###

####

Mailing Address

So we know where to deliver the I.C.O.N. shirts when they are ready!

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Customization

Please tell us where the port/g-tube is located.

Left Side Port - Chest

Right Side Port - Chest

Left Side - Abdomen

Right Side - Abdomen

Upper Middle Chest

Please let us know any of the warriors favorite colors, characters or things.

We will try to find t-shirts that fit the warriors personality (we will do our best to match the request).

T-shirt Size

Please choose the childs tshirt size. **Keep in mind, sometimes chemo can cause the patient to gain weight.

Optional Questions

The next questions are optional but are very helpful when our organization applies for grants. The grants, along with generous donations from our supporters, help us fund our programs and provide I.C.O.N. shirts to other pediatric patients like yours.

Reduced/Free Lunch

Does your child receive reduced or free lunch when attending school?

Yes

Military Affiliation

Is your family affiliated with the military?

What hospital is the warrior being treated at? (please include city/state)

Photo Release

Once you receive the I.C.O.N. shirts for your warrior, we ask that you send us a photo of your warrior in the shirt. The photo can be while your warrior is receiving treatment or not. By checking this box below, I hereby grant Stay Strong Foundation, Inc the absolute right to reproduce, display and disseminate worldwide and in perpetuity, in any traditional or electronic media format, my likeness or my child's likeness as shown in the photograph(s) I submit for the purposes given above.

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