Kyra's Hope Foundation

Submit a Milestone Wish

Birthdays, bell-rings, and finish-line celebrations deserve extra sparkle. Share the details below and we'll follow up within a few days to curate thoughtful gifts, decor, or notes from Kyra's Hope volunteers. Share a few details and we’ll follow up within 3 business days.
Note: There is a limit of 1 milestone gifts per year upto $100.

Application submitted by *

Child's Name *

Milestone *

What is your milestone wish? *

Child Date of Birth *

Diagnosis *

Parent/Guardian Name(s) *

Home/Cell Phone Number *

Email *

How did you hear about this program?

Shipping Address

Address Line 1 *

Address Line 2 / Room

City *

State *

Zip Code *

Hospital/Medical Facility

Hospital Name *

City *

State *

Zip *

Hospital Social Worker Name *

Hospital Social Worker Phone *

Hospital Social Worker Email *

By checking the following boxes I accept the following termsI understand that this is a gift to my child. The organization is not liable for harm caused by this gifts.I give permission to use a photo of my child to help promote this program. No last names or addresses will be disclosed.I give the organization permission to verify the above information with my child’s medical contact listed below.

Parent/Guardian Signature *

Date *