Living The Dream Foundation

Apply for a #DREAMDAY

If you or someone you know is suffering from a life-threatening illness and would like to be considered for a #DREAMDAY, please complete the form below.

Who is completing this form?

This Participant's Parent/Guardian
General Practitioner
Recipient
Other

Who is this Dream Day for?

Recipient information

NameAgeTo which gender idendity does the recipient most identify with?

Select...

CityState

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Instagram Username(or other social media handle, please specify platform - Twitter, Facebook, etc)PhoneEmailRecipient's IllnessHow did you learn about the #DREAMDAY program?Please share about how you or the recipient is "Living The Dream" despite living with a life-threatening illness.(800 words or less)Please list a few of your favorite bands, artists, entertainers, influencers, athletes, etcWhat specific upcoming festival, tour, event or experience are you submitting/writing in for? What date and location is the event (city & state)?

Does the recipient have problems with communication?

Does the recipient have problems with vision?

Medical professional information

Please list your medical doctor, specialist, or general practicioner to confirm your conditionHospitalNameAddressPhoneEmail