Nomination Form

To be added to our waitlist, please fill out the form below and tell us who deserves a pair of custom kicks to inspire hope and provide joy in their life.*

Your Name

First Name

Last Name

Your Phone

(###)

###

####

Your Email

Please let us know how we can keep you up to date on the progress of your sponsorship.

Who Would You Like To Nominate?

First Name

Last Name

Child's Age

Shoe Size

Indicate the size of shoe for your nominee and the age of the child. Please note the shoe size may be estimated up a half or full size depending on availability.

Foot Length (in inches)

Please measure the length of the child's foot from toe to heel.

Shoe Description

Write a detailed description of the shoes you would like our artist to create. Include favorite colors, themes, interests, characters or links to specific pictures for reference. Please note style of shoe may vary depending on availability.

Nominee Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Tell us why the person you are nominating would love a pair of custom shoes, including a little bit about the child and their diagnosis.

Social Media Links

We would love to follow along your nominee's medical journey. Please include any social media accounts you would feel comfortable sharing with us.

Thank you for your submission!

Be sure to check your junk mail for updates on your application. Add the branchandsparrow@gmail.com email to your address book to ensure no messages are missed.

*While we strive to communicate with each person submitting a nomination, we may periodically close the nomination window until we catch up with our orders. Please be patient as we carefully review and consider each nomination.