Wish Application

We’re working hard to grant a large amount of wishes right now. To help us process your application as quickly as possible, please be sure to answer all questions.

We’ll also need medical and media releases as well as the signature of your child’s primary physician. Download them here, then print, sign and send the completed documents by one of the following:

Email: clarissa@awww.org
Mail: 3751 West Freeway, Fort Worth, TX 76107
Fax: 817-731-3399

*Required

Child's Information
Child's Name*
First Last
Birthdate*
Month
Day
Year
Age*
Race*
Gender*
Shirt Size*
Medical Condition / Diagnosis
Hidden
Please attach a copy of your child’s birth certificate.
Accepted file types: pdf, jpg, png, doc, docx, Max. file size: 5 MB.
Home Address*
Street Address Address Line 2 City State ZIP Code
Legal Mother’s Full Name*
Legal Father’s Full Name*
Does the child reside with both biological parents?*
If no, with whom do they reside?
Who has custody of the child?*
- Mother
- Father
- Joint
Legal Mother / Legal Guardian Information
Are you the primary contact?*
Legal Mother’s / Legal Guardian’s Full Name
First Last
T-Shirt Size
Address
Street Address Address Line 2 City State ZIP Code
Primary Telephone*
Email
Occupation
Primary Language
Marital Status
- Married
- Divorced
- Separated
- Widowed
- Single
Do you have a valid driver’s license?
- Yes
- No
Upload copy of driver's license.
Accepted file types: pdf, jpg, png, doc, docx, Max. file size: 5 MB.
Birthdate*
Month
Day
Year
Please indicate if you are an active member or veteran of the military or first responder:
- Yes
- No
Legal Father / Legal Guardian Information
Are you the primary contact?*
Legal Father’s / Legal Guardian’s Full Name
First Last
T-Shirt Size
Address
Street Address Address Line 2 City State ZIP Code
Primary Telephone*
Email
Occupation
Primary Language
Marital Status
- Married
- Divorced
- Separated
- Widowed
- Single
Do you have a valid driver’s license?
- Yes
- No
Upload copy of driver's license.
Accepted file types: pdf, jpg, png, doc, docx, Max. file size: 5 MB.
Birthdate*
Month
Day
Year
Please indicate if you are an active member or veteran of the military or first responder:
- Yes
- No
Sibling Information
Please list all brothers and sisters under 18 years of age residing with Wish Child.
Please attach a copy of the birth certificate for each child living at home under age 18.
Accepted file types: pdf, jpg, png, doc, docx, Max. file size: 5 MB.
Sibling 1 Name
First Last
Birthdate
Month
Day
Year
Age
Gender
- M
- F
Sibling 1 Shirt Size
Legal Parent(s) Name(s)
Who has custody of child?
Sibling 2 Name
First Last
Birthdate
Month
Day
Year
Age
Gender
- M
- F
Sibling 2 Shirt Size
Legal Parent(s) Name(s)
Who has custody of child?
Sibling 3 Name
First Last
Birthdate
Month
Day
Year
Age
Gender
- M
- F
Sibling 3 Shirt Size
Legal Parent(s) Name(s)
Who has custody of child?
Wish Information
Have you contacted any other organization about your child’s wish?
- Yes
- No
If yes, please specify which organization(s) and what their responses was. Be sure to attach copies of any letters regarding denial of your child’s wish.*
Prior wishes granted, indicate dates and organizations.*
What is your child’s wish? Please remember that only ONE wish can be granted; however, we ask that you list three in case one or more are not possible.
Wish No. 1*
Wish No. 2
Wish No. 3
Tell us a about your Wish Child’s favorites.
Color:
Movie/TV Show:
Character:
Snack Food:
Book:
Sport/Team:
Game/Activity:
Any other information we should know about your Wish Child?
Physician and Medical Information
Hospital
Clinic
Physician
First Last
Office Telephone
Fax
Email
Social Worker
First Last
Office Telephone
Fax
Email
Child Life Specialist
First Last
Office Telephone
Fax
Email
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3751 West Freeway
Fort Worth, TX 76107
817-469-9474
Contact Us

Celebrating more than 40 years granting magical wishes for young Texans with life-threatening medical conditions.

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Child's Information

Legal Mother / Legal Guardian Information

Legal Father / Legal Guardian Information

Sibling Information

Wish Information

Physician and Medical Information