Refer a Child

Every day, we rely on referrals to help us directly reach each child in need. The form below is not an official acceptance into our program – it is a request to receive additional information. The requirements to be eligible for consideration are:

Must be considered low income and need financial support to provide your child a birthday
Must be submitted by the Parent(s) / Legal Guardian in need of assistance
Must live within the continental USA (we are unable to ship to Alaska, Hawaii and Puerto Rico at this time). We typically ship packages so an address is required. If you do not have an address - please note that in the comments below.
Child must currently be younger than 12 years old
Submissions must be received within the month that is three months before the child’s birthday month. The submission window (April 1st – April 30th) is now open for July 2024 birthday referrals.

Guardian's Name

First Name

Last Name

Guardian's Email

Guardian's Phone

(###)

###

####

Child's Name

First Name

Last Name

Gender

Child's Date of Birth

* Please ensure you select the correct YEAR

YYYY

Is the child under 12 years old?

Shipping Address

This is where we will ship the Birthday Kit.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please tell us more about yourself.

(This information will be used in the review process)

Please tell us why this support would help.

(This information will be used in the review process)

How many other kiddos under 12 are in your household?

(Please provide First Name and Age of each child)

Comments

Ideal Arrival Date

YYYY

I certify that I am at least 18 years old, the above information is truthful, and I have read and accept Operation Birthday's Privacy Policy and Terms & Conditions. I understand that my story will help connect with donors, so I provide permission to use this information anonymously for marketing purposes. Personal information will not be disclosed.

This information is linked in the Footer under Privacy Policy and Terms & Conditions.

Yes, I Agree.