Sibling Support Program - Tom Coughlin Jay Fund

J.A.Y.S. Team – Just Among You Siblings

A Sibling Support Program

Recognizing that childhood cancer affects the entire family, Tom Coughlin Jay Fund Foundation offers a unique program for siblings of children with cancer. J.A.Y.S. (Just Among You Siblings) Team is a psychosocial program with educational components that offer evidenced-based comprehensive, personalized support to the school-aged and teenaged siblings of pediatric patients.

Eligibility for J.A.Y.S. Team:

Must be a sibling of a patient diagnosed with childhood cancer
Siblings must be between the ages of 6-18 years old
Family must reside in North Florida or Southern Georgia

To receive more information on the program, please fill out the form below.

If you have any questions, please contact [email protected].

Relationship to Sibling being referred:*
Parent/Guardian information:
Name*
Prefix First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
State County of Residence:*

Please note that this program is currently open to select counties in North Florida and Southern Georgia.
Patient Information:
Patient's Name:*
First Last
Date of Birth:*
MM slash DD slash YYYY
Patient's cancer diagnosis:*
Patient's Date of Diagnosis:*
MM slash DD slash YYYY
Hospital/Treatment Facility Name:*
Sibling Information:
Sibling (1) Name:*
First Last
Sibling (1) Date of Birth:*
MM slash DD slash YYYY
Sibling (2) Name:
First Last
Sibling (2) Date of Birth:
MM slash DD slash YYYY
Sibling (3) Name:
First Last
Sibling (3) Date of Birth:
MM slash DD slash YYYY
Additional Siblings' Names and Dates of Birth:
Referring Medical Professional's information:
Name:*
Prefix First Last
Profession
Your hospital/clinic:
Patient Information:
Patient's Name
First Last
Patient's Date of Birth:
MM slash DD slash YYYY
Patient's diagnosis:
Patient's Date of Diagnosis:
MM slash DD slash YYYY
Hospital/Treatment Facility Name:
Sibling Information:
Sibling (1) Name:*
First Last
Sibling (1) Date of Birth:
MM slash DD slash YYYY
Sibling (1) Name:
First Last
Sibling (2) Date of Birth:
MM slash DD slash YYYY
Sibling (3) Name:
First Last
Sibling (3) Date of Birth:
MM slash DD slash YYYY
Additional Siblings' Names and Dates of Birth:
Other
Thank you for inquiring. At this time the Jay Fund can only accept referrals from Parents/Guardians or Medical Professionals treating the patient and their family. Please share this link with them. If you or the family have any questions, please contact Kim Todd at [email protected]. Thank you again.

Pediatric Cancer Resource Guide

Upcoming Patient and Family Events

Scholarship Guidelines

Financial Impact of Childhood Cancer

J.A.Y.S. Team – Just Among You Siblings

Parent/Guardian information:

Patient Information:

Sibling Information:

Referring Medical Professional's information:

Patient Information:

Sibling Information:

Other