Request a wish for someone that has been diagnosed with a terminal illness aged between 18 and 55 years

Prefer to use a printed form? Download our PDF version below

Once you have completed your application, please scan or photograph the forms and email to: enquiries@purpleheartwishes.org

If you do not have access to email or you want to talk to us about your application, please do not hesitate to contact a member of the team on: 07388 514837.

Purple Heart Wishes is a small charity that relies 100% on wonderful fundraisers and donations.

To provide wishes, we must be cautious about how we spend our funds, therefore we cannot guarantee granting a wish during peak holiday periods.  Our aim is to work with, and support you, to find a solution to ensure lifelong memories are made.

We will endeavour to do everything we can to grant a wish for you exactly how you want it to be.  However, this may not always be possible and out of our control.

WE DO NOT ACCEPT APPLICATIONS FOR WISHES TO TRAVEL OUTSIDE OF THE UK

Download the PDF wish request form