Golden Wish Application Form

Golden Wish Application Form

Golden Wish is a program that gives Spanish Fork 60+ patrons the opportunity to fulfill a meaningful wish or experience they have always dreamed about. One wish per patron. The program brings joy, connection and a renewed sense of purpose by showing them they are valued, celebrated and never too old to make a wish!
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name & Phone Number
Tell us about your wish
Whose wish is this?
What is a dream or lifelong wish you would love to see come true?
Why is this wish meaningful to you?
Have you ever tried to do this before? If so, what stopped you?
Are there any special people you would like to share this with?
Do you have any physical or health needs we should consider when helping plan your wish?
Can we share your story (photo/video) to inspire others?
Signature
You may submit this form for yourself or for a family member, friend or loved one whom you would like to nominate.

Must be 60+ and a Spanish Fork Resident to participate.

The personal data you provide on this form is collected to deliver City services, programs, and information. Please review Spanish Fork City’s Privacy Policy Statement before submitting this form.
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Tell us about your wish