Warrior Beads Application

The Warrior Beads Program is now open for applications. Please remember that this program that serves participants in 16 countries is run by one person. It may take up to 8 weeks to receive your beads. 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.

Warrior Name *

First

Last

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

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 100 for any event then you will receive 100 beads of that color plus special beads for the amount over 100:

Dr. Visit/Clinic Visit – Dark Blue *

In Patient Hospital Day – Yellow *

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

ER Visit – Red *

Ambulance or Life Flight – White *

Needle Sticks (blood draw, injections, IV starts) – Black *

Port or PICC (start, removal) – Silver *

IV Medicine or Infusions – Orange *

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

X-Ray, CT, MRI, MEG, etc. – Olive *

EKG, Doppler, echo, etc. – Copper *

Surgery (per event/incision) – Stars *

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

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

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

New Wheelchair, Walker, etc. – Magenta *

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

Seizures – Purple *

Travel Far from Home – Sea Animal *

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