Refer a Hero
We are so excited that you have found Wichita's Littlest Heroes!! WLH's is a non-profit organization for children with life threatening medical conditions! Our requirements for an illness to meet "life threatening status" means without proper medical care and parent support this illness could result in death. Every application is fully reviewed and a member of our organization will contact you within 2 weeks (by the email address provided on this form) if your hero meets WLH's qualifications! Thank you!
Wichita's Littlest Heroes
Date of Submission
Life-threatening diagnosis first and others (please list all if there is more than one)
Date of Birth
City, State and Zip
Parent(s)' Names ( if you use other names on Facebook, or other places, please list all first and last names used)
Mom's Occupation and Employer
Dad's Occupation and Employer
Please discuss at some length how your child's diagnosis is currently affecting your daily life and what makes this condition life threatening.
Hero's T-Shirt Size
Siblings' Full Names, genders and Dates of Birth of each sibling (we need this information for Christmas for choosing appropriate Christmas gifts for siblings)
How were you referred you to Wichita's Littlest Heroes?
What do you hope to get out of being a member of our organization?
What are your families most challenging needs?
New friendships for my Hero
New friends for myself (parent)
Resources and Information
Food and Basic Necessities
Fun events with the family and the local memberships
A place to vent
All of the above
(The following questions are for demographic purposes only and we are required to track them for receiving grants. No specific family information will be used, only aggregate numbers.) Ethnicity of Hero
Hispanic or Latino
Annual Family Income
$100,000 or above
Number of people in household family. Please tell how many adults and how many children
Which description best fits your family?
2 parent family with 1 or more children
Single parent family with support and assistance from another adult (parent or other)
Single parent family with no or very little support and assistance from another adult (parent or other)
Please classify where you live
Metropolitan Urban (population over 50,000)
Suburban (small town outside metropolitan area)
Rural (in the country or in very small town of less than 300)
A copy of your responses will be emailed to the address you provided.
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