Return to mobile version

Referral Inquiry Form

This inquiry form is the first step to receiving a wish – it is not confirmation of eligibility for a wish. Your information will be forwarded and you will be contacted by a member of our wish-granting team.

Relationship to child

Your information

We value your privacy and will not share your personal information.

Optional

Please confirm your email address. We want to make sure we can respond to your request.

Optional

Message

Type the characters below



When should a child be referred for a wish?

It is our mission to bring hope, strength and joy to a child at the time of greatest need.  A child should be referred for a wish when his or her condition has progressed to the point that it is putting his or her life in jeopardy.  Therefore, the child’s physician must confirm he or she is in a life-threatening state at the time the referral is made in order for him/her to be medically eligible to have a wish granted.

Refer a child for a wish
Make-A-Wish® New Jersey
Samuel & Josephine Plumeri Wishing Place
1347 Perrineville Road
Monroe Township, NJ 08831
(609) 371-9474
Toll Free (800) 252-9474