Wish Box Application

If you know someone who has Cancer, please complete this Wish Box application form for them. An amazing Wish Box full of fantastic things will be created especially and sent directly to them from Jamie’s Wish Trust.

Before you start, they need to meet the following criteria to be granted a Wish Box:

1. They are age 25 or under.

2. They live in England or Wales.

3. They are currently battling Cancer.

4. This is their first application to Jamie’s Wish Trust (if they have previously received a Wish or a Wish Box from Jamie’s Wish Trust, the application will not be accepted).

Once the application is complete, Jamie’s Wish Trust will be in touch with you directly.

Please note. By completing this Wish Application you are providing Jamie’s Wish Trust with personal data. Your personal data will always be kept safe and secure by Jamie’s Wish Trust. Your data will never be shared with any other party. The only exception to this is when you give us permission in your Medical Consent Form to contact the medical consultant/doctor of the applicant. You are welcome to write to our head office address to ask us what data we store, how it is stored, who can see it, and if you would like your data deleted.

Please complete this form as accurately and in as much detail as possible. The wish application cannot proceed without all sections of this form being complete. Please note that if you are not the applicant’s (person receiving the wish) parent or guardian, it is your responsibility to get permission from the applicant’s parent or guardian to complete this application.

About the person completing this form (the referee)

About the person receiving a Wish Box (the applicant)

Applicant’s medical information

About the wish

Please note that some of these questions might not be relevant to every applicant, but please answer as many as possible in detail, so we can tailor the Wish Box to the applicant.

About the information you have provided

Do you give permission for Jamie's Wish Trust to add information about this wish box application onto our website and social media accounts?
The only personal data included is the applicant's first name, age and type of Cancer only. If you do not agree with this, it will be added as an anonymous wish application and no personal data will be included.

Do you give Jamie's Wish Trust permission to store the personal data included within this wish application so that we can complete your wish application?
This data will always be kept secure. Any hard copy will be inside a locked cabinet inside a locked room accessed only by approved Jamie's Wish staff. All electronic copies will be kept password protected. After the Wish Box is sent to the applicant, only one electronic copy will be kept secure for our records only. This information will never be shared with anyone outside of Jamie's Wish Trust. The only exception to this is if we contact the applicants hospital consultant, of which you give us permission to do so in your Medical Consent Form.

Do you allow Jamie's Wish Trust to make future contact with you after the completion of your wish box application?
Once the applicant has received their wish box we will delete all medical information about the applicant. We will keep the name and contact details only of the people within the wish application form. These are for our historical records only and will not be shared with any other party. At any time you can write to us asking us to delete this information. We may occasionally make contact to share Jamie's Wish news, events and updates.

Important Information

The wish application cannot proceed without completing all sections of this form. A copy of your application will be emailed to you (the referee) including a link to a Medical Release form which must be printed, completed, and posted to Jamie’s Wish Trust. Your application will be processed once this form is received. The application will be cancelled if this form is not received within 30 days.

Feel free to contact us on 01903 368524 or info@jamieswish.co.uk if you have any queries whilst completing this form, or after it has been submitted.

Your details will always be kept confidential. If you are granted a Wish Box, only the first name, age and town of the wish applicant will be added to our website. By completing this form you are giving us permission to do this.

CLICK HERE to see our Privacy Policy. It will open in a new browser tab/window. Then confirm below that you have seen it.

Thank you for completing this wish application.
Please press the SEND button.








About Jamie's Wish

Jamie’s Wish sends Wish Boxes to children and young adults in England & Wales that are facing the life threatening illness Cancer…

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