Application - Living the Dream Foundation

Dream Day Application

Who is completing this form?

Recipient Recipient's Parent/Guardian General Practitioner Other

Please Specify Other

Name of Person Completing Form

Name

Age

Gender

Male Female Self-Describe

Self-Describe your Gender

City

State

Phone

Recipient’s TikTok, Instagram, or Facebook page

Does the recipient have a GoFundMe?

Yes No

Please provide a link to the GoFundMe

Please give a short description of the recipient's Illness:

How did you learn about the Dream Day program?

Please share about how the recipient is "Living The Dream" despite battling a life-threatening illness.

recipient’s favorite bands and artists. Providing details will help our team identify unique Dream Day opportunities for the applicant.

Medical doctor, specialist, or general practitioner. This information is used to confirm your condition.

Hospital

Medical Professional's Name:

Medical Professional's Address:

Medical Professional's Phone: