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Refer a child

Before we get started

Please note that referrals cannot be made anonymously. We will not proceed without the prior knowledge and approval of the family involved. Please get the family’s permission before making your referral.

Has the child's family been made aware of this referral?

Yes, the family is aware of this referral

No, the family is not yet aware of this referral

Please get the family’s permission before making your referral.

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Great! First, we need to collect some basic information about you (the referrer)

Your first nameYour last name

What is your relationship to the child you are referring?Your email addressYour phone number

Your address Info

ProvinceCity or town

Street address

Apt, suite, etc. (optional)Postal code

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Perfect! Second, we need some information about the child that you’re referring

Child's first nameChild's last name

What is the child's date of birth?What is the child's illness?Is there anything else that you’d like to add? (optional)

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Almost there! Third, we need to collect information for the child’s parent/guardian

Parent/guardian's first nameParent/guardian's last name

Parent/guardian's email addressParent/guardian's phone number

Parent/guardian's address Info

ProvinceCity or town

Street address

Apt, suite, etc. (optional)Postal code

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Lastly, please enter the following information for the child’s doctor

Doctor's first nameDoctor's last name

Doctors's email address (optional)Doctors's phone number

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and command

Thank you! Your referral has been received and will be reviewed by our team.

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Home Events ResponderPalooza - The Beer Can Rewind

ResponderPalooza - The Beer Can Rewind

When?

Sunday

August 17, 2025

6:00pm

Fuzzy blue background outlines a bass guitar, while text reading "Responderpalooza" is featured in the foreground

Where?

The Beer Can

1 Granite Way

See on Google Maps

Once again, First Responders in our community are showcasing their musical talents while making dreams come true for sick kids in Manitoba.

ResponderPalooza is supporting The Dream Factory, a Manitoba-based charity that creates unforgettable moments for children and their families in our province facing life-threatening illnesses.

For more information please contact...