Warrior Beads Application

As of August 17, 2018 the Warrior Beads Program is only open to existing participants for refill requests. The program has reached 5,000 participants and that is all that I can handle at this time. It may take up to 8 weeks to receive your beads. Stay strong and never give up!
Thank You.
Chris & 1Boy4Change

Complete the form below to submit your request. You will receive the Warrior's first name or nickname, bead string, and then the beads for the medical treatments or events listed below. Use this form to order more beads when your Warrior needs them.

* Indicates required field

Warrior Name *

First

Last

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Age *

Gender *

Female Male

Favorite Color *

Is this your initial application or a request for more beads? *

Please enter the number of beads for each treatment or event - if your numbers are over 50 for any event then you will receive 50 beads of that color plus special beads for the amount over 50:

Dr. Visit/Clinic Visit – Dark Blue *

In Patient Hospital Day – Yellow *

P.I.C.U. or N.I.C.U or I.C.U. – Glitter Gold *

ER Visit – Red *

Ambulance or Life Flight – White *

Needle Sticks (blood draw, injections, IV start, port or picc line access) – Black *

Port, Central line or PICC (start, removal) – Glitter Silver *

IV Medicine or Infusions – Orange *

NPO (no food/water before a procedure or surgery) – Light Blue *

X-Ray, CT, MRI, MEG, etc. – Green *

EKG, Doppler, echo, etc. – Heart shaped bead *

Surgery (per event/incision) – Stars *

Respiratory Support (oxygen, vent, etc.) – Pink *

Catheter/Tubes (Feeding tubes, Foley, chest tube, etc.) – Lime Green *

Therapy – OT, PT, Speech (per therapy) – Khaki or Brown *

New Wheelchair, Walker, etc. – Magenta *

EEG, VEEG, Sleep Study, etc. – Clear Purple *

Seizures – Purple *

Travel Far from Home – Sea Animal or Transportation Bead - 10 max per order - small glow in the dark beads for more than 10 *

Chemotherapy – Clear Blue *

Radiation – Clear Green *

Blood Transfusion – Clear Red *

Do you need a Guardian Angel Bead? *

I Need More String *

Act of Bravery – overcoming a huge obstacle or medical challenge, something that made everyone say “wow, look what this Warrior did!!!!!” Special surprise bead when you share the event with us!

Number of Beads *

Share their acts of courage *

Do you need a Warrior Beads storage bag? *

Submit