Missions - MIB Agents

Hello Agents!
I am Alexis Johnson and I am 25 years old. I just recently reached 10 years being cancer free and seven years since my amputation.I will be attending medical school this summer and aspiring to become a pediatric oncologist specializing in bone cancers. I am currently living in San Diego, California and taking a year off from my studies. I live a very blessed life and I am fortunate to have a great support system from my huge family and friends. I have many hobbies. I enjoy being active, love baseball, science, and traveling.

I look forward to working with OsteoWarriors everywhere on their MISSIONS to Make It Better! If we can be of help to you, please contact me at MissionCommander@MIBagents.org.

From Mission Commander,
Alexis

Our Very First Mission – Alyssa

Mission Request Form

Patient Name

Patient's Birthdate

Shirt Size

Patient's Diagnosis

Diagnosis Date

Is there a medical reason we need to act quickly?

Warrior's Hobbies, Favorite Things

Parent/Guardian Name

Birthdate

Shirt Size

Parent/Guardian Name

Birthdate

Shirt Size

Sibling(s) and Birthdate(s)

Street Address

City

State

Zip Code

Moible Phone

Home Phone

Hospital Name & Address

Treating Physician

Referring Person's Name

Referring Person's Email

Warrior's Caring Bridge or Facebook Page to Share

Has child received an experience or wish from other organizations?

If yes, please explain

Upload a photo of child to be used on mission card

Signature and Date Submitted

Please Note: MIB Agents may contact the child’s treatment facility for clearance if Mission Request involved travel or activity. Submission of Mission Request Form is not a guarantee of mission acceptance. You will be contacted within 48 hours by MIB Agents Mission Commander for more information.

By submitting this form you agree to the release of submitted photo and all photos taken during the mission to be used at MIB Agents discretion on social media and on website and all printed materials. No photo will be used unless the mission is accepted.