We help children under the age of 21 with medically related hair loss. Our recipients are both boys and girls of all ages under 21 years old, with different hair colors and textures. We make every effort to provide a hair replacement that is very similar to your natural hair color and texture!
Please fill out and submit the online form below, then we will contact you about your hair replacement needs.
In addition to the application, birth certificate and doctor verification of diagnosis, please provide a picture with and without hair so it can help us design the hair replacement. These pictures will not be shared and only CWHL will use them. When the package is delivered to the home, salon, or hospital, a signature will be required.
Please complete the application below to become a CWHL recipient. If you would rather print out an application, you may download the PDF by tapping the button below the form. If you have any questions about applying for Hair Replacement please give us a call or send us an email! We look forward to helping with your Hair Replacement.
990 and Financial Statements available upon request by email [email protected]
