Custom Instrument Requests — Ollie's Orchestra

Proudly Serving the pediatric cancer community ages 0-21!

Request your free Instrument below!

Custom Instrument Program!

Is there an instrument that you or a child with cancer at your location would like to learn? Please tell us about it below and we will do our best to fulfill your request!

Tell us about your custom instrument request!

If you would like to request an instrument for your child, please fill out this form and we will do our best to fulfill your instrument request as soon as we are able.

Name

First Name

Last Name

Email

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Instrument Name

What is the instrument you would like?

Child's Name and Age

Is your child in active treatment?

At this moment, our priority are children in active treatment. If your child is currently not in treatment, but you would still like to request a backpack, please do so and we will do our best to fulfill all requests.

Where is/was your child being treated

Please name the hospital your child is/was treated?

Please include any further information about your child or family that you would like us to know.

Are you requesting instruments on behalf of a hospital that serves children?

If you are affiliated with a children's hospital and would like to partner with us to receive instruments, please fill out the form above and provide additional details in the form below.

Lessons?

Would you like us to try to arrange instruction for this instrument?