Application

Download our Dream Application here or complete the online application below! Please upload completed applications here.

Step 1 of 6

Dream Child Information
Full Name of Child*
First Middle Last
Date of Birth*
Age*
Gender*
- Male
- Female
Illness*
Diagnosis Date*
Race*
T-Shirt Size*
Address*
Street Address Address Line 2 City State ZIP Code
Legal Mother's Full Name*
First Middle Last
Legal Father's Full Name*
First Middle Last
Does the child reside with both biological parents?*
- Yes
- No
Alternate Guardian*
First Last
Who has custody of the child?*
Other Guardian*

Sibling Information
Sibling's Full Name
First Middle Last
Relationship
Date of Birth
T-Shirt Size
Legal Guardian 1 Name
First Last
Legal Guardian 2 Name
First Last
Who has custody of the child?
add additional siblings
- (+) Add additional siblings
Sibling's Full Name
First Middle Last
Relationship
Date of Birth
T-Shirt Size
Legal Guardian 1 Name
First Last
Legal Guardian 2 Name
First Last
Who has custody of the child?
add another siblings
- (+) Add additional siblings
Sibling's Full Name
First Middle Last
Relationship
Date of Birth
T-Shirt Size
Legal Guardian 1 Name
First Last
Legal Guardian 2 Name
First Last
Who has custody of the child?
add more siblings
- (+) Add additional siblings
Sibling's Full Name
First Middle Last
Relationship
Date of Birth
T-Shirt Size
Legal Guardian 1 Name
First Last
Legal Guardian 2 Name
First Last
Who has custody of the child?

Dream Information
Has the child ever received a wish from another organization?*
- Yes
- No
*Please note that we are a first-time wish-granting organization, and we are unable to help a child who has had a prior wish or dream with another organization.
If yes, with whom?
How did you hear about Children's Dream Fund?
A Dream Coordinator will be meeting with you and your child to discuss his/her dream. Your child’s dream idea does not need to be decided at this time, but if they have ideas, please briefly describe:
Dream Idea 1 (Optional at this time)
Dream Idea 2 (Optional at this time)
All applications are reviewed by the Children’s Dream Fund and families will be notified upon approval. Dreams are granted at the sole discretion of the Children’s Dream Fund.
Authorization and Release:*
check if YES:
I do hereby request the Children’s Dream Fund to grant my (our) child’s dream set forth in the application submitted to the organization. I hereby authorize the Children’s Dream Fund to contact my child’s physician concerning my child’s illness and authorize the physician to release any and all medical information concerning the child, necessary for the Children’s Dream Fund to attempt to grant the child’s dream. I (we) further acknowledge and accept that there are certain risks to me (us) that may arise from participating in the activities of the Children’s Dream Fund including, but not limited to, risks associated with potential exposure to communicable diseases such as COVID-19, and I (we) knowingly and voluntarily assume full responsibility for any and all risk of personal or bodily injury, death, or any other damage or loss that I (we) may sustain. In consideration for participating in Children’s Dream Fund Activities, I (we), for myself and for my minor child or ward, and on behalf of my (our) heirs, assigns, beneficiaries, executors, administrators, personal representatives, and next of kin expressly release, indemnify and hold harmless the Children’s Dream Fund, its volunteers, officers, directors, agents, servants, representatives, employees, and dream participants (the “Released Parties”) from any damages, claims, demands, suits, causes of action, losses or liabilities, of any kind whatsoever, arising out of the activities of the Children’s Dream Fund, whether from the negligence of the Released Parties or otherwise, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Photo and Media Authorization Form:
I (We) authorize the Children's Dream Fund to release any information concerning the above-named child about his/her dream, illness or any related information to the below named outlets. If marked yes for news/print/video media, you are further authorizing the Children's Dream Fund to present to the general public any information and/or any photographs, recording, interviews and similar information which the media may gather about the above named child, his/his illness and the efforts of the Children's Dream Fund to assist the child and his/her family.
The individual or group that sponsored the child's dream in order to thank them properly*
- Yes
- No
The Children's Dream Fund website, newsletter, social media, reprinting of dream photos to be shared with hospital staff/in-kind donors/dream family, and potential news media (television, newspaper, radio or other communications or advertising mediums).*
- Yes
- No
Thank you so much for completing our online application. Once submitted, the application will be processed and under review. You will receive an email within the next two weeks providing the next steps. We hope to welcome you to the Children's Dream Fund Family soon. If you have any urgent needs, please contact us at 727-896-6390.

The Children's Dream Fund

Application

Step 1 of 6

Dream Child Information

Physician & Medical Information

Parent

Parent

Sibling Information

Dream Information

Photo and Media Authorization Form: