MIP Mental Health Days are an opportunity for a Teen Oncology patient to take a break from cancer. Perhaps more than any other time, peer relations are important. Teens often prefer to talk about their problems and concerns with friends. Or just forget about cancer and be just a teen. Laughter is truly the best medicine. So is connecting with friends. Help us give teens a day off.

Teen Name *

First Name

Last Name

Favorite Activities

Favorite Movies

Hobbies/Things the teen likes to do:

Any Additional information that will help us get to know the teen?

Teen would like to receive: *

Choose any that are of interest:

A Dinner & Movie Night out with up to 3 friends

An At-Home Pizza party with video game/movie

A Mini Shopping Spree (to get clothes that fit)

Organized activity with up to 3 friends:

Escape Room

Painting with a Twist

Color Me Mine

Mini Golf

Go Karts

Bowling

Other: enter suggestions in field below

Other: Suggestion of Activity

Suggested days/dates/times (in general) *

example: Weekends are best due to school or Need a less busy night of the week to avoid crowds .We will coordinate with you if the activity is date specific . .

Distance willing to go for experience *

Please realize that the activity your teen might be interested in receiving may not be available near home, and may require travel.

Nominator statement: *

Why is this teen in need of support from the MIP Foundation? How can we tailor our service to this teen to best help them cope with their cancer treatments?

Thank you for your submission. We will confirm receipt of your nomination, and follow up with any additional questions we might have to customize our offering, and to coordinate delivery to the teen.

Please do not forget to email us a copy of the signed Authorization/Release! We want to respect the parent/teens right to privacy - and can not accept a nomination without the signed Authorization.