Application Instructions

You can download the application by clicking on the link below,
or request an application by emailing
or you can request that we mail you one.

Download Application



  • Minimum age is 7 years old (at time of application)
  • Must not have had a previous wish granted by any other wish granting organization
  • The applicant must have a diagnosis of Severe Hemophilia A or B, or mild/moderate hemophilia and infuse factor prophylactically, or have an inhibitor.
  • Must be a U.S. citizen
  • Maximum gross adjusted household income of $75,000 per year
  • Wish requests can only be submitted by the hemophiliac applicant or their legal guardian.
  • The HemoWish Foundation grants one wish per “immediate family” (even if you have multiple children with hemophilia). Immediate family includes mother, father, and their children. Other family members such as cousins, uncles, grandfathers, etc.. may apply separately.