New Family Registration

2019 Recipient Families to Date — Pictured Above: 2013 – 2019 Recipient Children and Families

Recipient Application

If you know of a family in need of our services, please take the time to fill out all of the information in the form below. We will review as soon as possible and reach out to you with any further questions. Thank you for applying!

Name of the individual nominating the children*
First Last
Email of the individual nominating the children*
Phone of the individual nominating the children*
How many years ago did the family lose their loved one?*
- 0-12 Months
- 1-3 Years
- 3-5 Years
Address of Recipient Children/Family*
Street Address Address Line 2 City State ZIP Code

** Please note, this is the address of the recipient children, not your own.
Recipient Family Email*
Recipient Family Phone Number*
How are you related to the children for whom you are applying?*
Does the family have an income currently less than $75,000 a year?*
Is the family willing to assist in running the event for (2) years after receiving funding?*
What are the names and ages of the recipient children*
Please complete a brief description of the lost loved one including the following information: Nature of the loss, background and age of the lost loved one, any information on their character or highlights of their life that you would like to share*