Memory Application

We are honored to work with your family and look forward to creating a special memory for you that will help you take a break from your cancer diagnosis and have fun together.

Making a Memory

Thank you for your interest in Memories for Kids. We are honored to work with your family and look forward to creating a special memory for you that will help you take a break from your cancer diagnosis and have fun together. We review each memory request as quickly as possible and will make every effort to create a special memory or keepsake for your family. Please do not share the application with your children at this time. It’s a fun surprise for your children when the memory is presented to everyone.

To apply for a family memory, fill out the online application form on this page and download the required release forms and physician forms that must be signed and returned to us. If you prefer, you may download a PDF copy of the entire application package to complete in your own time. Once complete, you may return the signed forms to us.

Please include a photograph and personal letter with your application.
You may either upload these items with the online application form on this page, or mail them to us with your signed release and physician forms.

Photograph: It may include additional family members, pets, etc. May include more than one picture. Please identify those pictured.

Letter: Your letter should share your cancer journey and specifically identify the type of cancer you are battling. Clearly describe the type of memory you would like to create and why.

If you are not sure if your application is complete, please call us at (402) 889-5797 and we will happily answer your questions. If we receive an incomplete application, it will not be processed until all required information is received.

Applications can be submitted several ways:

    • Complete fully online (application to the right in grey)
    • Download full application below, complete, and submit using the “submit” button below.
    • Download full application below and submit to us via email or mail here:
      P.O. BOX 540216
      OMAHA, NE 68154-0216
      Save pdf file and email to

Who is eligible?

  • Memory recipients must have Stage IV cancer or similar as designated by your oncologist.
  • Must have at least one child under the age of 18 in the home at the time of referral.
  • Must be able to communicate the wish and actively participate in the memory experience, unless Memories for Kids is creating a keepsake item.
  • Must be a legal resident of Nebraska or Western Iowa at the time of referral.

What is the memory process?

  • After completing the application paperwork, return by mail to Memories for Kids at the address on the paperwork or scan and return by email to Please contact Memories for Kids if you need assistance completing the paperwork.
  • Once the application is received by Memories for Kids, a representative from Memories for Kids will contact you to schedule a get to know you meeting. This meeting is adults only.
  • After the initial meeting, Memories for Kids will coordinate dates if necessary and work to create a special experience for your family.
  • Once the memory is planned, Memories for Kids will contact you to schedule a time to present the plan to the entire family.

What do I need to be able to travel?

  • Memories involving overnight, or airline travel require that you have a valid driver’s license or a government-issued photo identification and a MAJOR CREDIT CARD. You must have a major credit card to be eligible to rent a car.
  • YOU NEED YOUR DOCTOR’S APPROVAL. Travel memories will require your doctor to sign our medical authorization form.
  • TRAVEL MEMORIES MUST BE SAFE AND REALISTIC FOR THE TRAVELER AND REALISTIC FOR MEMORIES FOR KIDS TO FULFILL. We will not consider memories outside the 48 contiguous United States including cruise requests.

What is included in a travel memory needing accommodations, and how long can I be away?

Travel-related memories needing accommodations last NO MORE THAN 3-4 NIGHTS and ARE NOT ALL-INCLUSIVE. You may be responsible for your own spending money to cover general fees and taxes, gas, souvenirs, tips, meals and other incidentals. We do our best, however, to provide transportation, meals, hotel accommodations, activity passes, etc. If you would like to extend the length of your stay, you may arrange that with Memories for Kids Travel Agent and pay for all related expenses.

Who can travel with me?

  • Memories for Kids will provide for the memory recipient and his or her immediate family members. This includes all children residing in the home, spouse or significant other OR an adult care giver.
  • If the memory recipient wants grandchildren or other relatives or friends to accompany them on the trip, the family is
    responsible for making those arrangements and payment for the additional accommodations, meals, etc. Memories for Kids discourages this as the time should be devoted to you and your children.

How are airline tickets handled?

  • For memories requiring air travel, we must raise the funds and/or obtain donated frequent flyer miles. Family and friends are encouraged to donate miles online or by contacting us at 402.889.5797.
  • If frequent flyer miles cannot be raised in time, flights may be purchased if funding allows. If funding is unavailable, the family may purchase the flights.
  • All flights are booked at least 14 days in advance in order for us to get the best prices on purchased tickets. Travelers must be flexible on their requested travel dates and times.

How is car rental handled?

  • Car Rental reservations will be made in the name of the Memories for Kids Memory Recipient.
  • In order to rent a car, Memory Recipient will need a major credit card in the name of the person who will be the designated driver. All drivers must be at least 25 years of age and listed on the rental car company agreement.
  • The Memory Recipient will be responsible for all charges at the time of the reservation and rental. Memories for Kids
    recommends purchasing insurance directly from the rental car company. Memories for Kids is not responsible for any charges incurred due to an accident, damage or in violation of any agreement with the rental car company.
  • The Memory Recipient shall request an itemized receipt from the rental car company when the rental car is returned.
  • The itemized charges shall be submitted to Memories for Kids. Memories for Kids shall then reimburse the Memory Recipient. Please submit the receipt to, text 402-889-5797 or mail to P.O. Box 540216 Omaha, NE 68154-0216

What if I require special medical assistance?

  • All medical assistance should be prearranged by your medical provider. This includes oxygen, wheelchairs, scooters, etc.
  • We cannot arrange or provide for hospice care away from home, dialysis treatments, or nursing care while you are away.
  • Should a memory recipient encounter a medical emergency while traveling we cannot assist with ambulance transportation, emergency room visits or hospital admissions. We cannot incur any additional costs deemed necessary for family members should their visit need to be extended while the memory recipient is hospitalized or with further arrangements if death should occur.

How long does it take to process a memory request?

  • The verification process of your application may take up to four (4) weeks. Please make sure your application is complete and everything required has been submitted (please refer to checklist provided). Missing information will delay or halt your application.
  • All aspects of each memory are subject to Memories for Kids Board approval.
  • Please keep in mind – Memories for Kids reserves the rights to its sole and absolute discretion to cancel/change preparation or fulfillment of the Memory at any time after signing the Agreement. Please ensure the information provided is true and correct.
Once you hit submit, you will see a thank you message pop up and a copy of your submitted application will be emailed to you. If you do not see the thank you message and receive an emailed copy of your application, please check for any errors and re-submit.