Family Application

Apply now for the family vacation of a lifetime.

The best gift in the world is the memories we make with the people we love. So where do you want to go? Now accepting applications for family travel. Applications are reviewed on a quarterly basis. Accepted applicants are notified via phone call and email. Thank you for applying to Always Lucy Strong!

Name of patient

Age of patient

Diagnosis date

Name(s), age(s) and relationship(s) of those traveling with the patient

Three desired travel locations, if known  

Has the patient been to any of these locations before?

If so, do they have a favorite resort or hotel in that location?

If requesting international travel, do all members of the traveling party have a valid passport? Passport should be valid for at least six months after requested travel dates.
 Yes No

Requested travel dates
[date date-203 date-format:mm/dd/yy]

Tell us a bit about the patient; their likes, dislikes, passions, etc.

What is the current net income of the patient’s family 

Does the patient have any special requirements? Are they in a wheelchair, do they have a feeding tube, etc. 

Is the patient a United States citizen?
 Yes No

Have the patient or traveling companions ever been convicted of a felony? If yes, please elaborate.
 Yes No

Has the patient or the patient’s immediate family ever served in the United States Military? If yes, please elaborate.
 Yes No

Please provide contact information, including your name, email address and phone number:

Your Name

Your Email

Your Phone Number

How did you hear about Always Lucy Strong?

Joshua RussellFamily Application