The Foundation provides one-time emergency funding to families who have a child receiving pediatric hospice care services, and are unable to pay for critical unfunded expenses. This can include but is not limited to paying utility bills, health insurance premiums, mortgage/rent payments, or other urgent, one-time emergency expenses. Children can also receive small gifts, fingerprint charms, photography sessions, and holiday gifts through this program. 

** Applications must be submitted by a member of the patient's hospice or palliative Care Team

Pediatric Emergency Funding and Gift Requests

Please download the program's policies and guidelines by clicking on the green tab.  

Please download and complete the application and send it and supporting documents (typed, signed letter (by social worker) on company letterhead that verifies the patient is currently on hospice services, or was on at the time of their death, and bill of $500 or less) to 

Some companies may be required to complete a W9 form in order to receive payment for services (e.g. a local repair shop or pest control company). Major utilities will NOT need to submit a W9.

When the application is complete and supporting documents have been obtained, please submit in .pdf form to  Please note, photos or documents scanned on a phone will not be accepted. Please scan all original documents on a computer.


If you, your family member, or your patient has received assistance from our Pediatric Care Program, please take a minute to provide feedback.

Requests for additional components may be made by a member of a pediatric hospice patient's care team. Each request is a two-step process.

First, click the green button to fill out the online form for the item(s) requested.


Next, download and complete this small gift written request form and/or charm written request form (to be signed by hospice professional and patient's parent or guardian). 

Scan and send signed documents to


"The Hospice and Palliative Care Foundation ensured that a pediatric patient and his family would continue to make memories despite his terminal diagnosis. The family had a minivan that had not worked in many years unfortunately this was the only automobile that would comfortably fit the patient and his entire family. With the assistance of the foundation, the family was able to purchase a new motor for the minivan. Now the family will be able to travel together and make new memories during this precious time. "


-Social Worker of Pediatric Patient



"It was a great stress relief. It was a blessing. Without the Foundation people like us would be in a world of trouble. We so greatly appreciate the assistance."

-Parents of Pediatric Patient


"No family prepares for the financial burden of the loss of child. In one particular case, our patient's parents were working hard to simply make ends meet. When their child passed away they worried they would not be able to pay for their child's burial. The foundation offered peace of mind and comfort in knowing they would have the finances needed to honor their child the way they wanted."


-Social Worker of Pediatric Patient

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