How to Apply for a Wish
Families or social workers interested in submitting an application for a wish from the Marty Lyons Foundation, must first ensure that the child meets our eligibility requirements.
ELIGIBILITY
- The Marty Lyons Foundation (MLF) grants wishes to children, ages 3-17, who have been diagnosed with a terminal or life threatening disease.
- Child must reside or receive medical treatment within the Foundation’s designated geographic locations:
- Alabama
- Connecticut
- Florida
- Georgia
- Maryland
- Massachusetts
- New Jersey
- New York
- North Carolina
- South Carolina
- Texas
- Virginia
- Please note that we are resuming our 2nd wish program in a limited capacity. There must be a minimum of 2 years since a child has received a wish from a previous organization. These applications will only be considered under exceptional medical circumstances. Should you have further questions about a specific application, please contact us.
INSTRUCTIONS
- Four (4) forms are required
- Parent’s – To be completed by the child’s parents
- Physician’s – To be completed by the child’s doctor
- Release & Indemnification – To be completed by the child’s parents and notarized
- Authorization to Release Protected Healthcare Information – To be obtained directly from the child’s medical facility and completed by the child’s parents
- Upon completion, all four (4) forms are to be mailed to MLF’s headquarters
- The Marty Lyons Foundation; 354 Veterans Memorial Hwy; Commack, NY 11725
Downloadable Application Files:
Release and Indemnification Form
FOR MORE INFORMATION
Please call us at 631-543-9474 or send us a message