Parents, Guardians FORM - Cape Ivy [New]

Parents & Guardians of a Child in Need

Poncho Request Form

Thank you for your interest in requesting a poncho for your child. This form is for parents and guardians only.

Cape Ivy donates ponchos to medical facilities rather than routinely shipping individual ponchos. This allows Cape Ivy to reach more children while keeping costs as low as possible. If the facility where your child is receiving care does not accept donations, Cape Ivy may be able to ship an individual poncho after first trying to work with the facility.

If possible, please ask a staff member to submit a request for ponchos for the facility. Staff requests allow Cape Ivy to provide ponchos to multiple children and are the preferred method of distribution.

If a staff member is unable to make the request, parents and guardians may contact Cape Ivy directly using the form below. Please provide as much information as possible about your child’s hospital, clinic, or other place of care, including the name of a Child Life Specialist or other staff member. This will help Cape Ivy contact the appropriate person and determine the best way to provide ponchos.

Name of Parent (or Guardian)

This form is to request a poncho for a child in your care. If this is for a relative or a gift, please visit our shop.

Please double check that you have typed the email address correctly so that we can reach you.

Is your child in treatment currently?

Yes, inpatient
Yes, outpatient

Cape Ivy ponchos are designed to work with IV lines and ports and are given to children in medical treatment for chronic or critical illnesses.

Name of hospital, clinic, Ronald McDonald House

We will ship ponchos to the facility where your child receives treatment, if allowed by the facility. We will mark one for your child.

Name and Email Address of a Staff Member

Please provide contact information so that we can make arrangements to ship a box of ponchos including one for you child. This might be the Child Life Specialist assigned to the clinic, infusion center, or hospital unit where your child is receiving treatment or a staff member at Ronald McDonald House or other housing facility where the family and/or patient is staying near the hospital.

Poncho Details

Please provide age and gender of your child, along with interests and/or likes or a specific print you have seen on our webpage or social media pages. The sizes are toddler, child (approximately ages 5-12), and teen. We will try to accommodate the request as best we can.