(888) 896-1588

Apply for a Hairpiece

If your child needs a hairpiece, please fill out the application and send the requested information via Certified Mail or your preferred carrier (Federal Express, UPS, DHL, etc.). We need all of this information before the Board of Directors can grant approval.

Hairpiece Application

Send Applications via certified mail to:

Case Manager
Locks of Love
234 Southern Blvd.
West Palm Beach, FL 33405

For more information, call us at (561) 833-7332 or email a Case Manager.


All requested material must be submitted

  1. Printout of completed application. (PDF)
  2. Medical Information: What is the cause of the child's hair loss? Is the loss of a permanent or temporary nature? Who is the child's physician? Please include a medical diagnosis. Doctor's office may fax information directly to Locks of Love at (561) 833-7962.
  3. Financial Information: Please include a copy of the most recent TAX RETURN or if receiving public assistance, please include a copy of state and/or federal benefits. Please include any documents that verify extenuating financial circumstances. Each case is reviewed individually.
  4. Personal Information: Please submit a photo of the child without a hairpiece or hat to help us with the custom fit and at least two letters of recommendation from a parent, a teacher, a friend, coach, etc. explaining why the child would benefit from a hairpiece.


Locks of Love is a non-religious, non-political, not-for-profit entity. Further, Locks of Love does not take positions or align itself with any special interests. Any event taking place as part of a religious, political or any other special interest group does not reflect the views or opinions of Locks of Love.

It is Locks of Love’s mission to promote the well-being of children through its program of providing hairpieces. All events and fundraisers held on behalf of Locks of Love should uphold and reflect the mission and desire to help disadvantaged children.

Locks of Love. 234 Southern Blvd. West Palm Beach, FL 33405-2701
Phone (561) 833-7332 Fax (561) 833-7962 Toll Free (888) 896-1588

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