Referral

Refer A Child - Make A Wish Request

Wish Application Wish Application - Spanish

To refer a child who meets the criteria for a Wish, or to make a Wish request:

Please complete the attached Wish Application. Please answer all questions and sign where indicated. The signature of a child’s primary care physician is also necessary for work to begin on a child’s Wish. Incomplete forms must be returned for completion, resulting in unnecessary delays. When the form is completed, please mail it to:

a Wish with Wings, Inc.
917 West Sanford Street
Arlington, TX 76012
A representative will contact you to discuss details of the Wish. Wishes will be granted within six months of receipt of your child’s request unless special circumstances require other arrangements. If a Wish is not granted within the six month time period, another Wish Application must be completed.

Please feel free to call our office with questions regarding your child’s wish. Business hours are 9:00 a.m. to 5:00 p.m., Monday through Friday. When we are out of the office, an answering machine will accept messages of any length. Please be sure you leave a daytime phone number so your call can be returned.

(click for larger image)

Amanda "Mandy"
11 years old

Diagnosis:
Aplastic Anemia

Wish:
Meet Mark Callaway aka WWE "The Undertaker"

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