Family Application

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Mission

Our mission is to bring joy to children with significant health or life altering conditions and relief to their families by creating happier and more functional living spaces.

What We Do

Welcome Home Angel serves families with children who have chronic conditions, physically debilitating injuries, or significant developmental disabilities who are restricted by limitations in the following areas of major life activity: self-care, mobility, or capacity for independent living. We serve children ages 4-18 in the Wilmington region.

We renovate the child's bedroom (and sometimes other living spaces, depending upon need). Many renovations are primarily aesthetic to enrich the environment where the child spends so much time and calls their own, but other renovations are major, to include door widening, handicap accessible bathrooms, and ramps. We also do a makeover of any siblings' bedrooms so they don’t feel left out.

We respect the privacy and confidentiality of all information that we receive about each family, whether we accept their case or not.

APPLY NOW

This application is the first step you must take for your child to be considered for Welcome Home Angel’s services. Once your application is received, we will contact you soon with more information.

The services that Welcome Home Angel provides to you and your family are completely free of charge!

YOUR CHILD

Gender
MaleFemale

MEDICAL CONTACTS

Do we have your permission to call medical providers to speak with them about your child’s condition? Note: you may be required to file medical release paperwork with your provider prior to WHA being able to discuss your child’s condition.
YesNo

YOUR CHILD'S CONDITION

Does your child require a wheelchair?
YesNo

Does your child require an oxygen tank?
YesNo

Does your child require a Gastrostomy Tube?
YesNo

Does your child require a catheter?
YesNo

PARENT(S)/GUARDIAN(S)

Are you this child's...
Biological ParentLegal GuardianNeither

Preferred Method of Communication
Phone CallTextEmail

Do you live with the child on a full-time basis? If not on a full-time basis, we will request custody agreements and/or proof of custody.
YesNo

OTHERS IN THE HOME

Do others live in the home who are not siblings or guardians?
YesNo

HOME INFORMATION

Is your home owned or rented?
OwnedRented

If your home is owned, is it owned by you?
YesNoNot Owned

If your home is rented, would you be willing to commit to a long-term lease in your current home?
YesNoDo Not Rent

Do you own the furniture in your home?
YesNo

TELL US MORE

DEMOGRAPHIC INFORMATION