How to Refer a Child

Anyone can refer a child for consideration to A Special Wish Cleveland Chapter. Brothers, sisters, neighbors, nurses, doctors, family and friends can help be a part of something special!

Once the below form is filled out, please be patient with us to hear back from one of our wish granters. Unless you mark it is an emergency wish on the form below, then a representative from our charity will be in contact right away.

Once a wish child is qualified, the family will be added into our Sparkles of Joy program and the Big Wish planning will begin!

Here are the qualifications to become A Special Wish Cleveland Chapter family:

  • Must be a resident in Cuyahoga, Lake, Summit or Geauga County

  • Child must have a life-threatening disease/condition

  • Child must be between the ages of birth up to the age of 21

  • Child has never had a ‘wish’ with any other wish granting organization

To get started, please fill out this referral form:

Wish Child's Information
Child's Name *
Child's Name
Does this wish need to be fulfilled within the next 90-days or less? *
Has the child received a wish in the past? *
Family Information
Parent/Guardian's Name *
Parent/Guardian's Name
Parent/Guardians' Phone Number *
Parent/Guardians' Phone Number
Referral Information
Who is referring this wish child? (What's your name?) *
Who is referring this wish child? (What's your name?)
Phone Number for Referral Contact *
Phone Number for Referral Contact