Granting wishes since May 3, 2014
It's our 5 year anniversary

Required Documents

1. Recent Photo of Wish Recipient

Must be clear and taken within the past year. It may include family, pet, etc.

2. Wish Statement
Your wish statement should:
  • be no longer than one page in length, one side, and refer to the illness you are battling
  • clearly describe your wish and where the most help is needed to make it come true
3. Proof of Household Annual Income

Please provide a copy of the signature page of your most recent tax return (Form 1040) or other proof of household annual income (e.g. SSI, Disability Statement or Bank Statement).

To be completed by physician only.

Recipient Basic Info

e.g. 12/30/1977. must be 18 years of age or older.

Recipient Contact Info

e.g. rose_87@example.com
e.g. 888-555-1212
e.g. 123 Main Street
e.g. Suite 200
e.g. 12345 or 12345-6789

Nominator Contact Info

e.g. tyler.gibson@example.com
e.g. 888-555-1212
e.g. self, spouse, sibling, physician, etc.

Recipient Medical Info

e.g. 05/2019. Month and year only.
e.g. physician, nurse, PA

Recipient Wish Info

e.g. 05/2019. Month and year only.
Annual household income may include social security, disability, medicare, etc.

Submission Agreement

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