REFER A CHILD and lets Dream Together!

Name of Parent or Legal Guardian *
Name of Parent or Legal Guardian

It is our goal to bring to life the dreams of every child facing cancer!  To that end, if you would like to refer a child to our project, please provide a bit of information in the fields to the left, including; the child's name, age, dream, type of cancer and any other pertinent information you feel is necessary.  We want to hear their story so be detailed!  You must be the legal parent or guardian of the child and the child must be between the ages of 0 and 18 years old.  We will then add them to our list and work to towards bringing their dreams to life!  

We will never, ever, ever, sell or market your information.  We only ask for this information so that we can contact you about your referral as well as better bring dreams to life!  We take your privacy very seriously and will not give out any personal information or contact information without your prior consent.