Laila's Gift Nomination Form

Nominee Information

Child's Full Name *

Child's Age *

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Child's City & State of Residence *

Child's Diagnosis *

To be eligible for a celebration, the child must not have been celebrated by Laila’s Gift in the past 36 months. Has this child been celebrated by Laila's Gift in the last 36 months? *

No

Yes

Nomination Details

Is the child celebrating a birthday or milestone? *

When is their big day? (Month/Year)

Why does this child deserve a Laila's Gift celebration? *

Are there any siblings in the family? *

No

Yes

If yes, how many siblings are there? *

What are the ages of the siblings?

Family Challenges

What are some of the biggest challenges the family caregivers face? *

Why would the family appreciate the celebration? *

Your Information:

First Name *

Last Name *

Phone *

Email *

Address *

City *

State *

Postal code *

Your Relationship to the Child *

Celebrations are brought to the doorstep of the family. We do not enter the home. Please provide the address for the requested Celebration *

Again, once you submit your nomination, please allow us up to 12 weeks for our Celebration Team to review it. If your nominee is selected, our Celebration Team will reach out to you to kick off the planning! If you don’t hear from us after 12 weeks, feel free to submit another nomination—but hold off on nominating the same child more than once within that time frame, as it won’t increase their chances of being selected.

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