Nominate a Child
If you know a child that you would like to refer as a nomination for a dream from the Jackson Sparks Foundation, please fill out and submit a form below.
Tell us about yourself (the Applicant)
Who is filling out this application?
First Name
Last Name
Email Address
Phone Number
What is your relationship to the child?
Parent\Guardian
Family Member or Relative
Medical Professional
Self
Other
Is the Family aware of the referral?
Yes
No
Please enter any other relevant information about you as the applicant
Nominee or Child's information
Tell us about the Child you are nominating
Child's First Name
Child's Last Name
Child's Gender
Male
Female
Child's Date of Birth
Does the child live primarily in Wisconsin?
Yes
No
Has the child ever received a prior dream\wish from another wish-granting organization?
Yes
No
Not Sure
What is the Childs favorite team? (e.g Brewers, Milkmen...etc)
What is the childs favorite player? (e.g. Christian Yelich, Aaron Judge...etc)
Dream Condition
Death of Immediate Family Member
Life-Threatening Illness
Critical Injury
Other Hardship
Additional Information (Tell us more about this child and their nomination)
I want to subscribe to the mailing list.
Submit
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