Hospital / Infusion Clinics / Medical Facility Poncho Request Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Hospital/Clinic Name *Name of Person Completing this FormWe like to be able to address you by name when we send you email.Title/Department of Person Completing this FormWe receive requests from different departments within the same hospital. This helps ensure that we are shipping to the correct contact/department/unit. Email Contact *We will contact you if we have questions or need to share information about your shipment. We will also send an acknowledgement email that we received your request. Please check your spam folder!Is this your 1st shipment?Yes! We just learned about Cape IvyNo. We love getting your ponchosHospitals are big! We receive requests from new units or new Child Life Specialists, even from hospitals where we have donated. The list of hospitals that have received Cape Ivy ponchos by state is listed on the accomplishments page, found in the ABOUT US menu. We can let you know who our current contact is. Shipping AddressPlease include department/floor/room and any other information so that the boxes will reach the correct location and person.Shipments1 box (16 to 20 ponchos)2 boxes (32 to 38 ponchos)1 now and 2nd automatically in 1-3 monthsIf selecting the 3rd option, please let us know in the next section when you would like the 2nd box shipped. Our typical box will contain 4-5 toddler-sized ponchos, 9-10 child-sized (ages 5-12) ponchos and 4-5 teen-sized ponchos. Please indicate if you would like a different distribution in the next section.Additional notes:Please share specific requests or comments.How did you hear about Cape IvyCCLS in a different departmentCCLS in a different hospitalSocial Media post by Cape IvySocial Media post by someone elseAd from a Google SearchChild wearing a ponchoOtherWe would love to know how you found us! Please provide additional information below, if relevant.Questions or CommentsLet us know how we can help you, what questions you still have, or any additional notes on how you found Cape Ivy.SEND REQUEST
