Wishers & Dreamers - Hospital Doll Gown Request Form
First Name of Child to receive gown *
Last Name of Child to receive gown *
Shipping address for gown (We don't ship to Hospitals) *
Street Address
City *
State *
Zip Code *
Country (if outside U.S.)
Child's gender *
Child's age (this helps us send age appropriate gowns)
Child's diagnosis
Child's likes (ie..colors, themes,)
Name of requestor *
Relationship to child *
Email address for requestor *
Comments
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
Submit
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