Central Illinois Dream Factory
"Creating a moment of a lifetime for chronically and critically ill children."

Do You Know A Child

 If there is a child you know and whose dream you'd like
to see come true, please print and fill out a Dream Request Form or submit this online nomination form.

Please, click here for Dream Request Form.

Referrals  
Child's Name
Child's Birth date
Child's Medical Condition
Child's Dream
Parent's Name
Parent's Phone Number
County
Physician's Name
Physician's Address
Physician's Phone Number
Referrer's Name
Referrer's Phone Number
Previous Wish/Dream Received

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