Request Form

By filling out this form you agree to allow the Prayer Child Foundation to use your story for marketing purposes. Please fill the form out completely!

Incomplete Information Will Not Be Considered

* indicates the field is required

Name of Individual Making Request:

No Yes

Gold Canyon Consultant

All Checks Will Be Sent Directly to the Consultant

Information for Donation Recipient:

Recipient address must belong to the recipient and the name must be a legal name (no nicknames please)

No Yes

If you would like to send pictures, please send with the child's name to