Dream Come True of Western Connecticut

Please get permission from the family before completing this form.
To refer a child for a dream fulfillment, please complete the accompanying form.
Be sure to read the eligibility guidelines before referring a child.
Someone from Dream Come True will contact the child's family.
Please click the "Submit" button only once and wait for a reply.

Your Name
Your Phone Number
Your E-mail address
Child's Name
Date of Birth
Parents' Names
Street Address
City
State
Zip
Telephone		Please include area code.
Diagnosis:

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