Request a Moment

Please fill out this questionnaire in detail so that we can assess the eligibility of the situation.

Eligibility Criteria:

Full name of the nominated person

Age of the nominated person

If the nominated person is a child, name of the child's parent or guardian

Your full name

Email to reach you

Your relationship with the nominated person

Your phone number

Mailing address to reach you

Summary of the situation justifying the request for a moment

How could we help?

Attach any document that may support the request (Maximum 3 files. Accepted formats: jpg, pdf, png - 2 MB maximum)

What happens next?

If the request is accepted:

If the request is declined:

A communication will be sent to the person who submitted the request to inform them that the request has been accepted within ten business days after submission.
A communication will be sent to the nominated person so they can confirm if they wish for Family at the Forefront to organize a moment for them.
If the nominated person agrees, Family at the Forefront will begin the process to organize the moment.
It is possible that Family at the Forefront may conduct an interview with the nominated person before making a final decision.

A communication will be sent to the person who submitted the request to inform them that the request has been declined within ten business days after submission.