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?

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 2024.

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

Email

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:

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.

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