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Referral Inquiry Form

This inquiry form is the first step to receiving a wish – it is not confirmation of eligibility for a wish. Your information will be forwarded and you will be contacted by a member of our wish-granting team.

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Your information

We value your privacy and will not share your personal information.

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Please confirm your email address. We want to make sure we can respond to your request.

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A wish improves a child's state of mind, replacing fear with happiness.

Who can refer a child?

Medical professionals, parents, legal guardians and potential wish kids can initiate the referral process.

Find out how to refer a child if you don't fit this criteria, or if the child lives outside of the United States and its territories.

Who is eligible?

A child with a life-threatening medical condition who has reached the age of 2½ and is younger than 18 at the time of referral is potentially eligible for a wish.

Read more on eligibility criteria for a potential wish child.

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Make-A-Wish® Tri-Counties
4001 Mission Oaks Blvd.
Suite F
Camarillo, CA 93012
(805) 676-9474