Daisy's Wishes application form

Wish Request

Any information provided will be completely confidential. We cannot guarantee that we will be able to grant all dream requests. DAISYS WISHES GRANTS DREAMS IN THE ISLE OF WIGHT AREA ONLY AREA. To enable us to process your dream as quickly as possible, please ensure all areas are completed, including the Publicity Consent Form as appropriate, and return to us together with a photograph of the child.
Please make sure you meet the below criteria before filling in this form.

Families with a child who is in end of life care.

Siblings that have just lost a brother or sister due to a disability or illness.

Children with a life limiting disability or illness that will not get better and has a big impact on their life.

For a child to be eligible to have a wish granted the child must:

1. Be currently living with a serious or life-limiting illness or have a sibling that meets the above criteria.
2. Aged between three and 18 years of age*
3. Be resident on the Isle of Wight.

4. Not have had a wish granted by another wish granting charity

*applications will be accepted until the day before the child's 18th birthday

What is a wish?

Wishes are unique to each child and can be anything from meeting a hero, swimming with a mermaid , the latest games console or a trip away.

All wish applications are assessed on the child’s individual circumstances and the medical information provided on the form. We will need to work closely with your medical team to ensure the wish is suitable for the child.

We cannot guarantee what type of wish can be granted upon application and encourage you to put down three different types of special wishes.
Child Name

First NameLast Name
Child Date of Birth

MonthDayYear
Date
Childs Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardians Name

First NameLast Name
Parent/Guardians Telephone Number
Please enter a valid phone number.
Parent/Guardian Email
example@example.com
Name of person completing this form

First NameLast Name
Relationship to child
Telephone number if different from above
Please enter a valid phone number.
Email if different from above
example@example.com
Nature of Childs Illness
Childs Dream - please give up to 3 wishes in order of preference. *only 1 wish can be a holiday
How did you hear about Daisys Wishes/Daisy Chains
Has your child already had a wish granted by another charity or are you waiting the outcome of another application at this time.
If yes to the above please give more info
Please attach a recent photo of the child

Cancelof
I would like this dream to be fulfilled for this child

Clear
Date

MonthDayYear
Date

If you require any help filling in this form please email us at daisychainsiow@gmail.com

To Proceed further with the wish application we need some extra info. Please give a brief description of your Childs disability or illness.
Details of mobility and extra needs
Name and address of Childs GP and 1 Hospital consultant and 1 Physio/OT/ Therapist
To enable us to grant the wish we will sometimes open a specific fundraiser for this to share on our socials/website to enable us to raise the funding to complete the wish. please use the dropdown box to agree to us doing this and to use any photos that have been provided - this usually results in wishes being granted sooner- please be aware if you do not agree it may take us some time to be able to raise the funds for this wish.

We promise never to pass on your details to another organisation for marketing purposes. We will store your data confidentially and securely. Our privacy policy covers in more detail how we store and protect data. Everything you tell us will be treated confidentially. I agree to The Dream Factory storing information about me/my child.

Agree
We will get back to you as soon as we can with the outcome of your application, please be aware we can usually only process 1 wish at a time and this means you may have a wait before we can grant the wish.

Children in end of life care will be prioritised over other wishes.

Please make sure you have read all the guidelines and that your child fits our wish granting criteria.

Thank you
Should be Empty:

Wish Request