Family referral and interest form

Are you interested in learning more about Pickles Group?

Do you know a family who can benefit from our youth services?

Pickles Group Family Referral and Interest Form

Pickles Group provides free peer support and resources to kids, ages 6-18, affected by their parent or guardian’s cancer. If you are making a referral on behalf of a family, please only submit with the express consent of the family's primary contact. Families may personally express interest using our Referral and Interest form. We will follow up with your referral within 2 business days.

The information you provide is confidential. It will only be used by Pickles Group to engage with parents, guardians, caregivers or other family members for the purpose of enrolling the children of interested families in Pickles Group's youth programming.