Making Magic for children that need it the most!

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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.
  • Date Format: DD slash MM slash YYYY
  • The Condition

  • (condition or illness wish child suffers from if applicable)
  • (name of hospital or hospice attended by wish child if applicable)
  • The Family

  • NameAge 
  • The Referrer

  • This field is for validation purposes and should be left unchanged.