Application – Kidd's Kids | DFW Based Non-Profit

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Primary Contact Information

Primary email address for communications:

Primary phone number for communications:

Please Tell Us

How did you find out about Kidd’s Kids?

What market/city is the Kidd Kraddick Morning Show heard on in your area?

Nominated Child's Information

General Information

First Name

Middle Name

Last Name

Suffix

Sex of the child:

Birthdate (MM/DD/YYYY)

Age

Grade Level

Developmental Age

Developmental age is the age at which your child functions emotionally, physically, cognitively and socially.

Later in the application you will need to upload a copy of the nominated child's birth certificate or most recent shot record to show proof of age.

Address Where Child Resides

Address Line 1

Address Line 2

City

State

Postal Code

The nominated child currently resides with:

Please explain:

Medical Information

What is your child's medical condition?

Please give us a short description of your child's medical condition:

Please list any medications your child is currently taking:

Please give us a short description of the medical treatment or attention your child is currently receiving:

What do you have to do to care for your child?

Travel Restrictions

Does your child have any travel restrictions?

YesNo

Please explain travel restrictions:

Wheelchair Information

Does your child utilize a wheelchair?

YesNo

When is the wheelchair utilized?

All of the timeOn occasionOnly for distance

Will you bring you child's wheelchair on the trip?

YesNo

Will your child require a wheelchair accessible room at the hotel?

YesNo

What kind of wheelchair?

ManualElectric

If your child uses a wheelchair for distance (or when they get tired), can they use a wheelchair that is provided at the hotel or parks without bringing the wheelchair from home?

YesNo

Additional Medical Information

Does you child require other special medical equipment for their care or comfort?

YesNo

What types of special medical equipment?

Will your child require oxygen on the trip?

YesNo

When will your child require oxygen (select all that apply)

In-Flight / PlaneHotelParks

Please explain your child's oxygen needs and dependencies:

Does your child require a 24-Hour nurse/caregiver that is a non-family member?

YesNo

Will you need this 24-Hour nurse/caregiver on this trip with you?

YesNo

What kind of help will they provide for your child?

Does Medicaid cover the nominated child?

YesNo

Does the nominated child receive any disability payments?

YesNo

Medical Doctor Information

Child's Primary Doctor Information

Name of child's primary doctor:

Hospital/Clinic where your child receives care:

Primary Doctor's phone number:

Primary Doctor's secondary phone number:

Other Doctors, nurses, or child life specialists who regularly see your child:

Please create a response for each Doctor, Nurse, or Child Life Specialist by clicking the "Add Another Doctor, Nurse, Child Life Specialist" button at the bottom of this section.

Name

Phone

Position/Title

Family Member Information

On the following sections please list all family members who live in the same household with the nominated child and their relationship to the child. Family members invited to attend the Kidd’s Kids trip are the child’s parent(s)/legal guardian(s) and siblings, between the ages of 4 and 18 years of age, who currently reside in the child’s household.

Only those family members that are eligible and listed on this form will be invited to attend the trip if the child is selected.

All sections for each family member must be complete (Full legal name, relationship, age, and date of birth). Add additional family members as needed. All family members over the age of 18 years must have a United States Government issued photo ID in order to attend the trip.

I agree that all adults 18+ on this application have or will have a valid United States issued photo ID or passport in order to board a domestic flight in November 2023.

I agree: (Please Initial)

I understand that if I have a child under the age of 4 (at the time of the trip), they will not be invited to attend the Kidd's Kids Trip. In the event my family is selected, I will make arrangements for them to stay with a family member or friend while we are out of town.

I agree: (Please Initial)

Parent/Legal Guardian(s)

Please complete the required fields for each Parent/Legal Guardian

Parent(s) / Legal Guardian(s)

First Name

Middle Name

Last Name

Suffix

Relationship to nominated child:

Please explain:

Date of Birth (MM/DD/YYYY)

Sex of the Parent/Guardian:

Address Information

Address Line 1

Address Line 2

City

State

Postal Code

Contact Information

Cell Phone

Work Phone

Home Phone

Preferred Phone

Employer Information

Employer Name

Job Title / Position

Length of time with current employer

Address Line 1

Address Line 2

City

State

Postal Code

Annual Household Income:

Insurance Information

Do you currently have Medical Insurance?

YesNo

Medical Insurance Provider

Relationship to primary insured:

Does this insurance cover the nominated child?

YesNo

Medical Information

Please list any medical conditions/diagnosis

Please list current medications

Have you had any surgeries in the last 12 months?

YesNo

Please list surgical procedures:

Siblings

First Name

Middle Name

Last Name

Suffix

Date of Birth (MM/DD/YYYY)

Age of Sibling

Sex of the Sibling:

Relationship to nominated child:

Relationship Description

Medical Information

Please list any medical conditions/diagnosis

Please list current medications

Have they had any surgeries in the last 12 months?

YesNo

Please list surgical procedures:

Other Wish Trips

Other Trips/Wish Granting Organization Information

Have you applied to have a wish granted before from another organization or company?

YesNo

Wish Information

Please create a response for each wish trip your child has applied for by clicking the "Add Another Wish" button at the bottom of this section.

Organization/Company Name

Year Applied (YYYY)

Wish Description

Was the wish granted?

YesNo

Is the wish still pending?

YesNo

How long has your child been listed?

Is this wish for a trip to Disney World?

YesNo

Is this wish for a trip somewhere else?

YesNo

Where is the trip to?

Give Kids The World Village

Has your child ever stayed at Give Kids The World Village in Orlando, FL?

YesNo

If yes, what year? (YYYY)

Disclaimer

*Kidd’s Kids verifies all prior Walt Disney World wishes with Give Kids The World. If a child has already been to Disney World through another wish-granting organization, they will NOT qualify for Kidd’s Kids.

I Understand (Please initial)

Last Vacation

Where did your family go on their last vacation?

When was this vacation?

Kidd's Kids Trip Information

Have you received a trip or offer for a trip to Disney World from any other organization?

YesNo

Are you available to travel Thursday, November 16th - Monday, November 20th , 2023?

YesNo

Would a trip to Disney World be possible for your child without the help of Kidd's Kids?

YesNo

Have you ever applied to Kidd's Kids?

YesNo

What year(s)

Have you even been placed on the alternate list for Kidd's Kids?

YesNo

What year?

Has your child ever visited Disney World (not a wish trip)?

YesNo

What year?

Has anyone who will be listed on the application ever been on a Kidd's Kids trip?

YesNo

What year?

Litigation

Is anyone in the nominated child's immediate family currently involved in litigation?

YesNo

Please explain litigation:

Documentation Upload

**Please upload all documentation at the same time right before you submit the form. If you leave this page your documentation uploads will not be saved**

Kidd's Kids will not accept phots of documents, they must be in a PDF or other office file format.

Example: Do NOT take a photo of a physician form on your phone and upload the image.

Nominated Child's Birth Certificate OR Shot Records

Please Select Document Type

Birth CertificateShot Records

Nominated Child's Birth Certificate (PDF)

Nominated Shot Records (PDF)

Kidd's Kids Medical Questionnaire

Kidd's Kids Medical Questionnaire (PDF)

Give Kids The World Medical Authorization

Give Kids The World Medical Authorization (PDF)

Tax Return

First two pages of the family's most recent tax return (PDF or Word Document)

Nominated Child's Photo(s)

Photo of nominated child (JPEG or PNG)

Supporting Documentation (Optional)

A letter of support is a letter that can be written by anyone in the nominated child’s life (i.e. nurse, teacher, therapist, family friends, family members). Letters of support do not necessarily help or hurt an applicant, they just give some more information about the child and family being nominated. The child’s parent(s) may also write a letter if they wish to expand on any information listed in the application.

You may submit your application before providing/uploading any letters of support. If you would like to send letters of support after submitting the application, please email them to Lyndsay@kiddskids.org and include the nominated child's first and last name in the subject line.

Supporting Documentation (PDF, Word, Excel)

Once you hit SUBMIT, you will be taken to the signature page where you will be able to review all your answers and make changes, if needed.

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Primary Contact Information

Address Where Child Resides

Medical Information

Travel Restrictions

Additional Medical Information

Medical Doctor Information

Family Member Information

Parent/Legal Guardian(s)

Siblings

Other Wish Trips

Kidd's Kids Trip Information

Documentation Upload

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© 2022 Kidd's Kids / All Rights Reserved

CONTACT US

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© 2022 Kidd's Kids / All Rights Reserved

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