In order to have your child be considered for this amazing FREE wig, please fill out the application form below.
**Please also know that by filling out the form you are agreeing to have your child photographed and videoed if chosen for the free wig. We want to share your story and help others going through hair loss as a child, and as the parent of a child with hair loss. So please do not fill out the application if you are not comfortable with your story being shared. All information on the application form will be kept confidential until someone has been picked and we have reached out to the legal guardians.