Refer a NICU/PICU Sibling
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Have you received a prepackaged gift from us from the hospital (some hospitals have these available)? *
Email address *
Please list details here (name of hospital patient is being seen at, illness etc.) *
Your Name *
City and State in which you live *
Relationship to the child/ren you are referring *
How you heard about us *
Child's Name, Age, Gender - please list if more than 1 *
Physical Address to send children's gift *
Select One *
Please describe games or themes to purchase and if there are multiple children with various interests, please list them here (e.g. Child 1: Star Wars Legos, Child 2: Minecraft video game for Nintendo Switch, etc.) *
Anonymous Gift *
By acknowledging this I am allowing Charlie’s Guys to send a gift to the child/ren referred and assuming responsibility of the gift once it has been delivered. *
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