We are seeking families to host war-affected children who are undergoing medical treatment in New Jersey.

Each child will have different needs and requirements depending on the treatment they will be receiving.

Please fill out this form to express your ability to host.

Name

First Name

Last Name

Subject

Address

Please tell us a little about yourself

Are you comfortable with making your home or vehicle ADA accessible?

Are you comfortable with the possibility of installing special equipment in your home or vehicle? (e.g. safety beds, wheelchair ramp, etc)