YES DAY Nomination Form

YES DAY Nomination Form

YES DAY is dedicated to creating extraordinary moments of joy for children and young adults facing life’s toughest challenges through the power of YES. Our vision is a world where every child — regardless of their circumstances — gets a day where everything is YES.
Thank you for taking the time to nominate a child to YES DAY. We are incredibly grateful for trusted community partners like you who help us identify deserving kids and families who could benefit from a little extra joy, love, and support.

Our goal is simple: to create moments of joy, hope, and unforgettable memories for kids who deserve a bright spot during challenging times.

We have two programs you can refer children and young adults, ages 5-21, for:

YES BAGS and YES DAYS!

Once we receive your nomination form, our team will be in touch to schedule a quick call to learn more about the child and family and determine which program may be the best fit.

Our model ensures that no child is excluded simply because their condition or life circumstance does not fit a traditional definition of “wish-eligible.”

Our YES BAGS are thoughtfully curated care packages filled with up to $1,000 worth of personalized items designed to bring immediate joy, comfort, encouragement, and support during a difficult season of life. Items may include things the child needs, loves, or has always wanted — from cozy comfort items and favorite snacks to electronics, sports gear, art supplies, toys, gift cards, sensory items, event tickets and more.

Our YES DAYS are fully personalized “24 Hours of YES” experiences built around what would bring that specific child the most joy and excitement. Every YES DAY is customized to the child’s personality, interests, dreams, and current circumstances.
- Ice cream for breakfast? YES.
- Front row seats to their favorite musician? YES.
- A shopping spree? YES.
- A spa day? YES.
- A day at the zoo, meeting athletes, limo rides, sleepovers, backstage access, surprise experiences, or simply a full day feeling celebrated and loved? YES.
Information about the child/young adult you are nominating:
Name of child/young adult you are nominating:

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
ex. 9
Sex
What significant life challenge(s) is this child/young adult currently navigating?
Ex. Cancer diagnosis, Down Syndrome, Foster Care, Poverty, Traumatic Brain Damage, Loss of parent
Why do you believe this child/young adult would benefit from a YES DAY experience?
Is there anything important we should know about this child or family?
Has this child/young adult had a "Make-A-Wish" before (or something similar)?
What brings this child/young adult joy? Please be as specific as you can!
Ex. Music, Sports, Family, Swimming, Shopping, Animals, Matt Olson, Cooking, Cars, Bijan Robinson
Referral Information
Referring Person

First NameLast Name
Referring Person Email
example@example.com
Referring Person Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Referring Organization
EX. CHOA, Shepherd Center, Gigi's, WinShape Homes, Dunwoody High School
Referring Person's Job Title
Referring Person's Relationship to the child/young adult
Is this referral for a YES BAG, YES DAY or lets talk it out together!
Parent/Guardian Information
Name

First NameLast Name
Relationship
Mother, Father, Legal Guardian
Parent/Legal Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Legal Guardian Email Address
example@example.com
Parent/Legal Guardian Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If the individual has brothers or sisters please provide their full names and ages.
EX. Brother: Joel Berman, 17, Two Sisters: Jasandra Berman, 13, Sami Berman, 10
Family's Primary Language
EX. English, Spanish, Hebrew
Is the family aware of this referral?
Yes or No
Signature of Referring Person
Thank you so much for referring a child or young adult for a YES DAY experience!

We will be in touch soon to schedule a quick call to learn more about this incredible child and explore the best way we can bring joy, hope, and support to them and their family.

If you have any questions in the meantime, please don’t hesitate to reach out to YES DAY Executive Director, Jodi Sonenshine, anytime at jodi@yes-day.org.
Picture of child/young adult being referred: (Optional)

Cancelof
Should be Empty:

YES DAY Nomination Form

Information about the child/young adult you are nominating:

Referral Information

Parent/Guardian Information