Apply for Wish Form – Magic Makers

Complete the form below or

Child Magical Memories Form

Completing this form only nominates a child and does not guarantee that all magical memories will be granted. Please be aware referrers are unable to nominate their own children.

The Child
If there is more then one child you wish to nominate from a family please complete a separate application form.
Child's Name
First Last
Child's Date of Birth
DD slash MM slash YYYY
Upload a picture of the child (If possible)
Accepted file types: jpg, gif, png, pdf, Max. file size: 30 MB.
Gender
- Male
- Female
- Other
Primary language spoke
Reason's For Nomination
Has the child received or registered for a wish from another organisation?
- Yes
- No
- Don't know
If Yes, which organisation
The Condition
Condition or Illness
(Condition or illness wish child suffers from if applicable)
Hospital or Hospice Details
(Name of hospital or hospice attended by wish child if applicable)
About the Child's Consultant/Doctor
Name of Consultant/Doctor
Consultants/Doctor's telephone
Name and address of hospital
Street Address Address Line 2 City County Post Code
Consultant/Doctor's Email
The Family
Parent/Guardian's Name
First Last
Siblings
Name Age
Home Address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Home Telephone
Mobile Telephone
Email
The Referrer
Your Name
First Last
Relationship to Nominee
Home Address (if different from above)
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Home Telephone
Mobile Telephone
Email
How did you hear about Partyman's Magic Makers?
Marketing Emails
- By ticking this box you agree to let us keep in touch with you via email with new offers and the latest news
Phone
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Name	Age

Complete the form below or

Child Magical Memories Form

The Child

The Condition

About the Child's Consultant/Doctor

The Family

The Referrer