Make-A-Wish Foundation International > Wishes >> Refer a Potential Wish Child

We grant the wishes of children with life-threatening medical conditions to enrich the human experience with hope, strength and joy.

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Wishes - Refer a Child

If you know of a child that might qualify for a wish, please complete the form below.

Referrals are accepted from any one of the following three sources:

Parents
Guardians of the child
Medical professionals
The children themselves
Family and friends

Make-A-Wish Wish Referral Form
First Name: *
Last Name: *
Your Relationship to Child: *	Parent / Guardian Medical Professional Self (potential wish child) Other
Address: *

City: *
State / Province: *
Postal / Zip Code: *
Country: *
E-mail Address:*
Confirm E-mail Address:*
Phone: *
Comments: