Referring a Child

Refer a child

Do you know a child or young person who is suffering from a life threatening illness? You can refer a child or young person for a wish with us today by filling out the referral form to the right.

Unsure whether they are eligible for a wish with us? Give Cathy our Wish Coordinator a call on 01202 514515.

Please note all referrals that we receive are treated in the strictest confidence.

For any further information please check our most frequently asked questions.

Referral Form

Fields marked with an * are required

Child's Full Name *

Child's DOB *

Child's Illness *

Hospital Attended

Parent / Guardian Names

Family Address *

Second Line of Address

County

Postcode *

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Other Info

Referrer’s Name

Relationship to Child

Referrer’s Telephone

Referrer’s Mobile Phone

Referrer’s Email Address

How You Heard About Us

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To the best of your knowledge:

Has The Child Previously Received A Wish?

Is The Child Registered With Another Wish Granting Charity?

We like to keep in touch with our referrers and send information on developments within Round Table Children’s Wish. If you do not wish to be contacted in future please tick the box. NOTE: At no time will we pass your information to other organisations.

Referring a Child

Refer a child

Referral Form

Further Details

To the best of your knowledge:

Corporates

Community Groups

Schools

Corporates

Community Groups

Schools

Corporates