Refer a Child

Children’s Wish Foundation International prides itself on providing quality, creative, and carefully researched wishes to children all over the world.

To Qualify

The child must be under the age of 18 at the time of the application.
The child must have been diagnosed with a life-threatening illness.
The child must not have received, or be in the process of receiving a wish.

Children’s Wish Foundation accepts referrals from:

Parents or legal guardians
Healthcare professionals
Children being treated for a life-threatening medical condition
Other family members

How to refer:

You can refer a child online by completing the below application.
You can also call us toll-free at 1-800-323-WISH (9474)

Referral Form

Child's Personal Information
Child's Gender*
- Male
- Female
Child's Name*
First Last
Child's Date of Birth*
MM slash DD slash YYYY
Child’s Diagnosis*
Has the child had a Wish from an organization?*
Parent / Guardian Information
Parent/Guardian Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Your Relationship to Child
As the person referring this child, please provide the following information should we have a need to contact you.
Referrer's Name*
First Last
Relationship to Child*
Hospital and Primary Care Information
Hospital Name
Hospital City
Primary Care
First Last
Primary Care Phone Number
Contact Information
How would you like to receive the wish application?*
Preferred e-mail or mailing address*
Your Signature*

This typed signature certifies that the facts contained in this form are true and accurate to the best of my knowledge.

Refer a Child

To Qualify

Children’s Wish Foundation accepts referrals from:

How to refer:

Referral Form

Child's Personal Information

Parent / Guardian Information

Your Relationship to Child

Hospital and Primary Care Information

Contact Information

READY TO JOIN OUR MISSION? DREAMS START WITH YOU!

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