Ink Well Pen Pals Request Form

Ink Well Pen Pals Request Form

If you are the Official Guardian* for a child who is facing serious illness or hardship such as neglect, abuse, or foster care, you may apply here to have a special drawing made just for them. We will do our best to find an artist from the child's favorite book, film or TV show to create their tailor-made drawing then we will mail it straight to them!

*To be an Official Guardian, you must have legal authority over this minor. An Official Guardian is usually a biological parent or court-designated guardian.

You will be asked to provide a doctor's note or other official medical documentation that confirms the child's condition. The doctor or medical facility must be currently operational. This is a requirement we must ask of all applicants in order to confirm eligibility. Anything we receive will be kept absolutely confidential throughout the review process and then will be permanently destroyed.

Your Information (all contact info will be kept comepletely confidential).

Full Name *

Phone *

Email *

Relationship to Minor

I declare that I am an Official Guardian for this child. *

Child's Information

Full Name *

Age *

Please describe the challenge this child is facing. *

Please list, in order of preference, the child's top three favorite books, cartoons, and/or films. *

Anything else we should know?

Address that the drawing should be mailed to: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Permission to Share

We would appreciate the chance to share this story through a brief description and photo of the child with the drawing they receive. It helps to spread the word about the Pen Pals program to other kids and lets them know that they are not alone in facing their challenges.

This is not required to participate. Please mark your preference below:

I hereby grant to The Ink Well Foundation the right to use my own and this minor’s name, likeness, and biography in order to publicize and promote its charitable activities across all media in perpetuity. *

I agree. I do not agree.