Make a Kid’s Dream Come True!

Know a child getting treatment for a life-threatening or debilitating condition in the East Tennessee region? Let us know – and we’ll do our best to connect them to a once-in-a-lifetime experience!

Dream Connection Nomination Form

First, tell us about YOU:

Your Name(Required)

First Last

Your Address(Required)

Street Address Address Line 2 City State ZIP Code

Your Email Address(Required)

Your Phone Number

Next, tell us about this special child:

Child's Name(Required)

First Last

Child's Birthdate(Required)

Must be 3 to 18 years old to qualify

Has this child received a dream from another agency? (Our bylaws don't allow us to do a dream for a child that has already received a dream)(Required)

Yes

Does the child live in one of the 16 East Tennessee counties of Scott, Campbell, Claiborne, Morgan, Anderson, Union, Grainger, Roane, Loudon, Knox, Jefferson, Hamblen, Monroe, Blount, Sevier, and Cocke, or does the child receive medical treatment at East Tennessee Children's Hospital or the University of Tennessee? (Our bylaws don't allow us to do a dream for a child that doesn't live or receive treatment in our area)(Required)

Yes

Are You the Parent/Guardian of This Child?

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Parent 1 Name(Required)

Parent 2 Name

Family's Address(Required)

Street Address Address Line 2 City State ZIP Code

Email Address(Required)

Phone Number

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Name of Facility Where Child Receives Treatment(Required)

Treating Physician's Name (optional)

Facility's Phone Number(Required)

Finally, tell us how you know this child and what makes them dream-worthy:

Tell us about the Child's Medical Condition:(Required)

Finally, Tell Us How You Know This Child and Why You're Nominating Them:(Required)