Visits and Donations Form

Visits and Donations Form

Thank you for your interest in visiting our hospital. At this time, we are completely booked through the 2013 holiday season. If you would like to donate items or schedule a visit in 2014, please fill out the form below.

Contact Us About Your Visit or Donation

Please complete the form below. You will receive a personalized reply from the Child Life program director.

Required Fields *







Donation?
Yes No

If yes, what? PLEASE NOTE: all donations must be brand new products
Teaching tools(Legacy Medikin Teaching tools, Memories Unlimited boxes, etc.)
Gift cards
Infant toys
Child toys
Electronics
Craft supplies
Swings or high chairs
Infant clothing
Children's clothing

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Please do not include any sensitive patient information in your response