Case Worker Wish Form This form is only for caseworkers of registered partner agencies only This Wish is pending approval by The Wish Project. You will be sent a confirmation.Case Worker InformationCase Worker First Name Case Worker Last Name Agency Program City Email Client Information DO NOT USE CHILDREN'S NAMES.Adult Client First Name Adult Client Last Name Adult Client 2 First name Adult Client 2 Last Name Ethnicity - Select -CaucasionAsianHispanicNative AmericanAfrican AmericanFamily Status - Select -HomelessDisaster VictimPeople with DisabilitiesRecovering AddictGrandparent as ParentLow IncomeFoster ParentOtherAdults - Male Adult - Female Children - Boys Children - Girls Due Date (Must be 1 month away to receive baby items) Wish ItemsFor Full and Queens must have 2 adults in bed. Twins are given to single adults and children over 3. We do not give out just box springs. Please put the number of each bed size you need below.Beds - Baby Beds - Toddler Beds - Twin Beds - Full Beds - Queen Heater / Air Conditioning - Select -HeaterAir Conditioning (Dr Note Required)Household Items Kitchen Table Dresser Sofa Love Seat Household Kits MicrowaveKitchen - Chairs Baby ItemsNewborn Baskets can be requested 1 month prior to birth & 1 month after birth.Baby Items Car Seat - Infant Car Seat - Toddler Carrier / Sling Stroller Double Stroller New Born Basket Play Mat High Chair Baby Bedding Diaper Bag Formula Safety Kit Safety Gate Baby Bottles Baby Wipes Baby SwingDiapers - Select -Size 1Size 2Size 3Size 4Size 5Size 6Pull-UpsBirthday Bag - Select -BoyGirlComments Submit Form
