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!
Email address *
Wichita's Littlest Heroes
Date of Submission
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Hero Name *
Life-threatening diagnosis first and others (please list all if there is more than one) *
Date of Birth *
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Street Address, *
City, State and Zip *
Phone Number *
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 *
Required
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? *
Required
(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 *
Annual Family Income *
Number of people in household family. Please tell how many adults and how many children *
Which description best fits your family? *
Please classify where you live *
A copy of your responses will be emailed to the address you provided.
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