Every young adult deserves to have a once-in-a-lifetime backstage experience.

To ensure a unique and personalized experience, ADIMS Agency has a standard process.

Who can refer someone to ADIMS Agency?

  • Referrals are accepted from medical professionals*, parents or guardians, immediate family member, close friends or a potential participant directly.
  • The participant/family will always be contacted once the referral is made before the planning phase of the experience begins. 

*Medical professionals could include a doctor, nurse, social worker, personal support worker or specialist with detailed knowledge of the nominee's current medical condition.

Eligibility:

  • The adult is between the ages of 19 and 30
  • The nominee has a life-threatening medical condition that is currently in the life-threatening stage
  • The nominee has not received a prior wish from any wish-granting organization
  • The nominee's treating physician deems them medically able to participate in the experience.

Privacy Policy:

A Day In My Shoes respects the privacy of our participants and their loved ones. All medical and personal information is kept confidential and is not communicated with outside parties unless consent is provided by the participant.

Questions about referrals? Contact us via email HERE

 

Refer a nominee Application Form

Your Name *
Your Name
Your Phone *
Your Phone
Your relationship to the person you with to refer: *
Please note: Out of respect for the privacy of the nominee and families we serve, participants must be referred by specific individuals (see list below). If you do not fall into one of these options, please ask the participant or family to visit our website, or contact us directly.
Nominee's Name: *
Nominee's Name:
Nominee's Date of Birth: *
Nominee's Date of Birth:
Nominee's Address *
Nominee's Address
Nominee's Phone *
Nominee's Phone