Wish Referral

Refer a Child to Have His or Her Wish Granted

To refer a child, please fill out & submit the form below or download the form and email it to Info@achildswish.org.

WHO IS ELIGIBLE?

A Child’s Wish of Louisiana has helped thousands of critically-ill Louisiana children’s wishes come true! Children between the ages of 2 – 18 years old who live in Louisiana and have been diagnosed with a critical illness – meaning a progressive, malignant or degenerative condition that places the child’s life in jeopardy – are eligible to receive a wish from our organization. The child should not have already received a wish from any other wish-granting organization.

WHO CAN REFER A CHILD?

Our mission is to reach as many Louisiana children as we can and the first step is having someone who cares tell us about a child who needs our help. We accept referrals from a child’s parent / guardian; from the child’s healthcare provider, including physician, nurse or nurse practitioner, or physician’s assistant; from social workers; or from a friend or family member with a detailed knowledge of the child’s medical condition.

Please note that the completed referral form is NOT an official application, but it is rather a request for that child’s family to be contacted and receive additional information.

Only a child’s parent or legal guardian may officially submit a child’s application.