"Covering Young Heads to Heal Young Hearts!"™
Children With Hair Loss provides to recipients a complete care kit along with a human hair replacement. We also provide support and education to our recipients and to our volunteer cosmetologists and barbers. Our services and products are provided free of charge to recipients annually until age 21!
What's in the box?
- Human Hair Replacement
- Styrofoam Head
- Suction Stand for Styling
- Hair Care Products
- Styling Brush and/or Comb
- Skin-safe Tape
- Head Wraps
HOW TO QUALIFY FOR HAIR REPLACEMENT
HOW TO QUALIFY FOR HAIR REPLACEMENT
1BE UNDER THE AGE 21
Just supply proof of date of birth by attaching to the form below. Example: Birth Certificate, Driver’s License or School Student I.D
2HAVE MEDICALLY-RELATED HAIR LOSS
You'll be asked to provide a physician's diagnosis that you're experiencing hair loss due to a documented medical condition.
3COMPLETE THE APPLICATION
Please fill out and submit the online form below or click the button to download the printable the PDF form, fill it out and send it to us. Then we will contact you about your hair replacement needs.
4SUBMIT PICTURE WITH APPLICATION
In addition to the application, birth certificate and doctor verification of diagnosis, please provide a picture with and without hair so it can help us design the hair replacement. These pictures will not be shared and only CWHL will use them. When the package is delivered to the home, salon, or hospital, a signature will be required.
APPLY TO BECOME A CWHL RECIPIENT!
Please complete the application below to become a CWHL recipient. If you would rather print out an application, you may download the PDF by tapping the button below the form. If you have any questions about applying for Hair Replacement please give us a call or send us an email! We look forward to helping with your Hair Replacement.