Apply for a Wig

To apply for a wig, you must…

  • Be under the age of 21. We’ll need a copy of your birth certificate, driver’s license or student ID.
  • We’ll need documentation from your physician showing  diagnosis of hair loss due to a medical condition.
  • A picture of what you want your hair to look like, and the measurament of your head.
  • Complete the online form or send us everything we need via fax, email to the address beleow.
  • We asl that you allow us to share your “before and after” pictures on social media to help spread the word of this wonderful cause.

We look forward to helping you get a wig.

Children With Hair Loss
12776 Dixie Hwy
South Rockwood, MI 48179
Tel: (734) 379 4400
Fax: (734) 379-8983
Email: info@freewigsforkids.org

Application Form

Yes I allow FreeWigsforKids to share my and/or my child’s story, name, photo/video online to help bring awareness to this great cause.

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