Request your backpack

Please fill out the shipping request form below to request your backpack. It can take up to 4-6 weeks for families to receive their backpacks after submitting their request form.

Backpack Program Eligibility Requirements:

Recipient is between 4-17 years old and a Canadian resident
Recipient has been newly diagnosed with arthritis or another rheumatic disease (within two years)
Recipient is under the care of a rheumatologist
Recipient has not previously received a backpack from the program

If you have questions about the program, please email backpack@arthritis.ca.

First Name of Parent*

Last Name of Parent*

Full Name of Backpack Recipient*

Age of Backpack Recipient*

Pronoun of Backpack Recipient

If other, please use these pronouns for the backpack recipient

Year of diagnosis*

Preferred language*

Email*

Phone number*

Address (please include apartment number, if applicable)*

City*

Province*

Postal code*

Referring Rheumatologist:*

Please select your backpack design preference, based on your child's age:*

I confirm that the backpack recipient has a diagnosis of arthritis or another rheumatic disease and consent to Arthritis Society Canada following up with our referring rheumatologist to confirm the diagnosis if necessary*

Yes

Arthritis Society Canada’s Club Sunrise offers free, year-round, virtual programming (e.g., cooking classes, paint nights, etc.) for children and youth ages 5-17 living with arthritis and their families. Is your child a Club Sunrise member?

How did you hear about the backpack program?

I would like to join Arthritis Society Canada’s mailing list to receive updates on childhood arthritis programming, research developments and advocacy initiatives.

I consent to my contact information being shared with Take a Pain Check Foundation, which offers resources for teens with rheumatic conditions.