Without Regrets Foundation
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Please read carefully and submit your information below.
Thank you for your interest in Without Regrets Foundation’s services.
Please read this page
carefully before filling out the short application that follows.
You should expect the application process to work as follows:
You submit the application online and ensure the
doctor approval form
is sent in by mail or email (email preferred).
Our Client Services Committee will review your application according to our parameters and available funds.
We will contact you with the committee’s decision.
If you are selected, our team will contact you to begin planning your experience.
If selected, your experience will be submitted to your physician for final approval.
Our committee has the right to reject any application for any reason. In order to be selected your request must meet the following criteria.
You must reside in the State of Texas.
Any children to be covered at Without Regrets’ expense must be ages 18 and under. If you have children over 18 that you wish to include on your experience, they would need to participate at your expense.
Any travel requests must be contained to the 48 contiguous United States (requests for travel to Hawaii, Alaska or out of the country will not be accommodated).
You must be a US citizen.
Any children you wish to participate that you are not a legal guardian of will need signed permission from their legal guardian that they are able to participate.
All experiences will occur within 60 days of your application approval.
*While we would like to provide these services to all families in such situations, costs can be a greater barrier for some; if paying for the experience is not a difficulty for you and your family, we request that you allow our donated funds to support families in greater need.
Examples of Memorable Experiences
Without Regrets’ mission is to help our clients leave lasting memories for their children. We want these memories to come from an experience that is
specific to you
as all people and all families are different. This is why each experience differs depending on the family.
Day phone number
Partner or spouse's full name
City, State, Zip Code
Evening phone number
Partner or spouse's email address
Please list all children and include each date of birth.
Please recall that one acceptance criterion is children under the age of 18. While older children are welcome to join you in your experience, Without Regrets does not cover those expenses.
What is the memorable experience you would like Without Regrets to provide for you and your family?
We ask each family individually because we want this to truly be the memory you would like to leave with your children. These have varied from showing children the ocean, showing children where you grew up, visiting family, attending a sporting event, etc.
what makes this experience particularly special to you and your family?
Why are you seeking Without Regrets Foundation’s assistance in fulfilling this experience? (For example; financial hardships, too busy to plan it, etc.).
Date conflicts within the next 60 days (we want to work around any treatment schedules):
If you are selected as a client of Without Regrets, would you be willing to speak at an event, to a group, to the media, etc. about your experience with our organization?
If available, please upload the physician referral form.
Max file size: 20MB
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