Apply for Assistance

Travel Assistance Application

At The Children’s Heart Lane, a 501(c)3 non-profit foundation, we understand the significant financial impact of having to travel outside of the Texas Panhandle for medical care and treatment for children facing chronic illness and disabilities. We help offset the costs associated with fuel, lodging, meals and hospital parking fees. In order to be considered for this program, please tell us about your family and how we can help you.

Parent's Name(s)

Phone Number

Mailing Address

City, State, Zip

Name of child needing medical care

Date of Birth

Medical Diagnosis

Local Physician / Hospital / Clinic Name

Out of town Physician / Hospital / Clinic Name

Approximate # of nights you will be away from home

Date(s) of Appointments

When will your 1st day of travel be?

Will you be staying at a Ronald McDonald House location?

Does your medical insurance provide any travel assistance?

How did you hear about us?

Please feel free to explain more in detail if you feel that it would help us make a better decision regarding your family's needs.

Please also email a picture or screenshot of your child’s appointment/hospitalization confirmation to info@childrensheartlane.org. Applications without this confirmation will not be approved.

**Each application will be reviewed by the Children’s Heart Lane Board of Directors. Applicants are not guaranteed to receive assistance. Please allow 3 days for review and response.**