Hospital Survival Kit Request
Child's Name (First and Last) *
Your answer
Parent(s)/Guardian's name. (First and Last name who is staying in hospital with child) *
Your answer
Child's age *
Your answer
Child's favorite's (color, interests/hobbies, shows, characters, etc...)
Your answer
Name of Hospital child is admitted to in San Diego. *
Your answer
Date of admittance *
MM
/
DD
/
YYYY
Estimated length of stay *
Your answer
Child's diagnosis *
Your answer
Name, relationship and email address of requester *
Your answer
Link to fundraisers, social media or website for the child's medical journey (GoFundMe, Facebook, Caring Bridge, ETC...) *
Your answer
We post photos of the care package and a little about the child receiving a gift. We only post the first name and and a brief blurb about the child's diagnosis. We do not post other personal information or in depth details about the child's medical journey unless we are hosting a fundraiser for the family and the parent gives permission. If requested, we can just use the child's first initial and leave out the diagnosis. *
Required
We love receiving photos of the child/family with their care package! Please send us photos after you receive your hospital survival kit! It makes a big impact to our donors when we post photos of these photos on our social media and website. We only post photos with parent's permission. *
How did you hear about us *
Name of answer from above
Your answer
Other Information
Your answer
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