Childhood Cancer Fnd
Seth Harris Childhood Cancer Foundation
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Copyright 2012: Seth Harris Childhood Cancer Foundation | Childhood Cancer Foundation | All rights reserved.
PO Box 1286, Bay Springs,  MS 39422, 601-739-3658 | info@shccf.org
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Seth Harris Childhood Cancer Foundation
PO Box 1286
Bay Springs, MS 39422

Create your own user feedback survey
The Seth Harris Childhood Cancer Foundation is compiling information on cancer statistics for Jasper County, MS. If you, or a direct family member lives, or has lived in Jasper County, MS and had any cancer diagnosis, please fill out the form below for each member of your family, with as much detail as you can remember. The list will be sorted, so don't worry about duplicates. Enter a separate survey for as many family members as you can remember, dating as far back as you can remember. Thank you for your contribution! Help us find answers for Jasper County!

Please read the following before proceeding to the survey:
​PRIVACY STATEMENT Your privacy is important to SHCCF. This privacy statement provides information about the personal information that SHCCF collects, and the ways in which SHCCF uses that personal information. The data requested in the form below, hosted by a third party, collects medical information regarding a possible cancer cluster in Jasper County, MS. The information you submit on this form may be submitted to cancer research organizations outside of Jasper County. Your participation in this survey is voluntary and any information you submit will be used to analyze trends and means in Jasper County. 

If you have questions about this survey, please email: info@shccf.org