Show Me Romey Sensory Bags

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Please fill out the form below. We will contact you via phone/email to let you know when the bag is available for pick up. Child must be 3-17 years of age.

Thank you!

Show Me Romey Team

Your Name *

Phone Number *

E-Mail - We will email you when the bag is available for pick up :)

Child's First Name *

Child's Gender & Age *

Child's Size - If needing a compression vest

Clear selection

Pickup Location *

Ace High Beauty - 116 W. Broadway St., Bolivar, MO

YMCA - 500 E. Elm, Lebanon, MO

YMCA - 932 W. Main St Buffalo, MO

Boho Beauty Co.- 114 N. Main, Urbana, MO

Check the 4 you're interested in: (1 swing per family) *

Sensory Swing-indoor

Noise Cancelling Headphones

Fidget Toys

Weighted Blanket--if checked please give child's weight in "additional comments"

Sensory Night Light

Air Dry Clay

Chewy Necklace

Sensory Body Sock - if checked please give child's size on "additional comments"

Loop Earplugs (older youth only)

Required

I acknowledge that the sensory items included in the sensory bag provided by Show Me Romey Foundation are intended to be used as described in accordance with the provided instructions and warnings. I understand that improper use may result in injury. To the fullest extent allowed by law, I agree to WAIVE, DISCHARGE CLAIMS, AND RELEASE FROM LIABILITY Show Me Romey Foundation, its members, officers, directors, managers, employees, volunteers, agents, other participants, and affiliated entities, from any and all liability on account of, or in any way resulting from injuries and damages connected with the use of the sensory items.

I accept

Any other additional information:

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