Test Child's Name * Gender * MaleFemaleNonbinary Specify pronoun, if desired Child's Birth Date * Parent/Guardian's Name(s) * Street Address * City * Postal Code * *To be eligible for a Dream the child must reside on Vancouver Island or the Gulf Islands. Contact Phone Number * Second Phone Number Parent/Guardian's Email * Physician's Name * Physician's Phone Number * Child's Condition * Dream Request * Comments Has the child had a Dream (wish) granted by any other organization? YesNoDon't Know If yes, name of organization Nominator's Name Nominator's Phone Number Nominator's Email Address