Heroes Form

"Some people never meet their hero, I gave birth to mine."
Sebastian Nicolas Ortiz, the second-born of three sons to Rose & Oscar Ortiz, was funny & kind, intelligent & athletic, handsome & humble - the kind of person you couldn’t help but love. He was a son & brother, a grandson, nephew, & cousin, a true friend, and a FIGHTER. Sebastian was diagnosed with embryonal rhabdomyosarcoma in October of 2015. He underwent numerous surgeries, 2 grueling chemotherapy regimens, and 23 radiation treatments. He lost weight & his hair. He lost the ability to run. He endured constant pain. But Sebastian fought bravely for 14 months - with patience, faith, & courage - and ALWAYS with a smile & kind word for anyone who visited him. He gave us STRENGTH!!! Sebastian’s fight ended on December 29, 2016, and the SebastianStrong Foundation was born. He will live on FOREVER in our hearts and in our fight to help find a cure for childhood cancer.
Please tell us about YOUR HERO. SebastianStrong will only share YOUR HERO’S name, type of cancer, picture, and “story”. All other information requested is for office use only. Children under the age of 18 are required to have a parent or guardian complete this form. The primary contact must be an adult. We require a telephone number for the parent/guardian or Hero (if over 18) to obtain permission to post the Hero on our site.
Hero Name*
First Last
Hero Date of Birth*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Type of Cancer*

Submitter Information
Submitter Name*
First Last
Relation to Hero*
Email
Phone
How did you hear about SebastianStrong Foundation?*
Would you like to sign up for our quarterly e-newsletter?*
- Yes
- No
Sharing your child’s story helps to make other people aware of the challenges children & families battling cancer face, as well as the need for increased pediatric cancer awareness & research. We promise to respect your family’s privacy and only use the information you provide in the manner described below. By submitting this form, you are granting SebastianStrong Foundation permission to share your child’s name, diagnosis, story, and photo on our website and other official digital channels, such as social media. SebastianStrong may also share this information in our newsletters and other printed materials. By checking "I Agree", I am allowing SebastianStrong Foundation to share my child’s name, diagnosis, story, and photo in the above-mentioned ways.
Allow SebastianStrong to share your child’s story (must be parent/guardian or adult Hero)*
- I agree
Tell Us About Your Hero
Please share any information you would like others to know about your Hero. This may include a short story about them, why they are your hero, something special about their personality, or their journey.
Please upload up to 2 photos of your Hero below: Files must be less than 2 MB. Allowed file types: gif jpg png
Accepted file types: jpg, gif, png.
Please upload up to 2 photos of your Hero below: Files must be less than 2 MB. Allowed file types: gif jpg png
Accepted file types: jpg, gif, png.