Wishers & Dreamers - Hospital Doll Gown Request Form
First Name of Child to receive gown *
Your answer
Last Name of Child to receive gown *
Your answer
Shipping address for gown (We don't ship to Hospitals) *
Street Address
Your answer
City *
Your answer
State *
Your answer
Zip Code *
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Country (if outside U.S.)
Your answer
Child's gender *
Child's age (this helps us send age appropriate gowns)
Your answer
Child's diagnosis
Your answer
Child's likes (ie..colors, themes,)
Your answer
Name of requestor *
Your answer
Relationship to child *
Your answer
Email address for requestor *
Your answer
Comments
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We love to receive pictures of patients with their gowned doll/buddy. Occasionally we share these pictures on our website/facebook page. *
Do you give your permission for any photos submitted to Wishers and Dreamers to be published?
How did you hear about us? *
Enter the name of: other/Group/Blog/Facebook Page/Friend Name
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