This inquiry form is the first step to receiving a wish – it is not confirmation of eligibility for a wish. Your information will be forwarded and you will be contacted by a member of our wish-granting team.

IMPORTANT NOTE

In the comments/question section of this form, please indicate your child’s life-threatening medical condition/diagnosis

SOMETHING TO CONSIDER

Please keep in mind that A Special Wish does not cold call families of potentially eligible children. We ask you to please exercise compassion and suggest to families that they contact A Special Wish directly.

A second-party introduction can be unsettling for a child or the family. We prefer that the referral process be as comfortable, inspiring and private as possible.

Wish Inquiry Form

Relationship to Child *
Your Name *
Your Name
Address
Address
Phone *
Phone
(111) 111-1111