Wish Referral Form | Make-A-Wish
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Wish Referral Form

To refer a child for a wish, we need a few details from you – about the child, their family, and their medical consultant.

If you have any problems completing this form, please call us on 01276 40 50 70.


Wish Child Details






Parent Details



Referrer's Details


 

Consultant / Doctor’s Details


I have read, understood and agree to the Make-A-Wish UK Wish Applicant Privacy Policy, and give my consent for the use of my personal data and special category data in line with the “Privacy Policy;” for the sole purpose of confirming my eligibility to have a wish granted, and, if deemed eligible, for the sole purpose of granting my wish.

If you would like to discuss any of the above further, please email [email protected].
For details of how to withdraw your consent at any time, please revisit the Make-A-Wish UK Wish Applicant Privacy Policy.