Hospital Survival Kit Request
Please fill out the request form and we will deliver a hospital survival kit to you and your child in a San Diego hospital. If you have a greater financial or other support need, please explain at bottom of form and we will do our best to assist you or to find additional resources.
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
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DD
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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 *
Financial or other assistance needed
Your answer
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