Request Your Phoenix Bear

Phoenix Bears can be weighted up to 30 lbs
(12lbs 1oz – 30lbs will be charged an additional fee to cover the additional expense)

Phoenix Bears that weigh:
up to 12 lbs (Waitlist Fee = $25 total)
12lbs 1oz – 17lbs 15oz (Waitlist Fee + extra expenses = $50 total)
18lbs – 30lbs (Waitlist Fee + extra expenses = $70 total)

An Express Pass is available for an additional fee and when you purchase an Express Pass, you will also be responsible for purchasing your base bear from Amazon. IF you choose an Express Pass to significantly reduce your wait time, you will need to promptly purchase your base bear from our “Choose Your Base Bear” Amazon WishList and have it sent directly to us. Be sure to include your Phoenix Bears order number. You will not be placed on the “Express Pass” until your base bear is received. **No more than 2 *Express Pass Bears* will be placed in each HUG** (a HUG is a group of teddy bears)

IMPORTANT: This form is for Phoenix Bears to be shipped within the USA! If you need your Phoenix Bear shipped outside the USA, please CLICK HERE!

*For multiple losses, please fill out one form for each baby if you want a bear for each baby. If you’d prefer one angel bear holding multiple 2″ baby bears, please fill out one form and put that information in the additional information section.

Only the bereaved parent can request a Phoenix Bear. Once your form is received, you will be placed on our Wait List. *

I confirm I am the parent of a baby who has passed away, and agree to allow Phoenix Bears to use pictures of my Phoenix Bear & my baby's name (first & middle) & weight on their website & social mediaAt this time there is a limit of 1 Phoenix Bear per baby. If you lost multiples you will need to fill out a form for each loss.

I am my baby's *"Mama" (mom)"Dada" (dad)Are you the bereaved mother or father?

Your Name *

Email Address *

Confirm Email Address *

Street Address *This form is for shipping within the U.S.A.

City *

State *

ZIP Code *

Baby's Full Name *Enter First Middle & Last Name (if un-named, you can enter nickname or "N/A")

Baby's Gender *

Baby's Weight (ex: 5lbs 4oz) *How much your Bear will weigh* *If weight is unknown due to miscarriage, please enter baby's gestational age (we will then use average weight for that gestation for your bear).

Baby's Length (in inches) *

Date of Birth or miscarriage *

Date of Passing (If different from DOB)

Enter a Date of Passing only if you want it included on your Certificate

Theme, Colors, Patterns that you associate with your babyWe cannot guarantee this, but will do our best to accommodate up to 2 requests.

Angel Wings *Yes ($7)No

Attached Blanket *Yes, attached via magnetic snap (for 3+ due to possible choking hazard)Yes, permanently attached (sewn directly on to paw)No blanketEach Phoenix Bear comes with a blanket attached to it's hand unless you opt out of this

Decorative Button for BlanketYes, add a decorative button to my bear's blanket (if applicable)No buttonWe add a decorative button to the attached blanket when it is a square (as opposed to a plush lovey) unless you opt out

add-embroidery

Embroidery for Belly Patch (up to 2 names)What you enter here will be exactly what is embroidered. If you don't desire any embroidery, type "n/a". NOTE: We do our best to fulfill requests but we can not guarantee more than one name will fit. If your baby has 2 first names such as Mary Beth, please note this in additional information section & we will do our best to include both first names. If the names are too long, we may only be able to include the first name. It is uncommon for 2 names not to fit.

Embroidery for Blanket ~ Up to 3 lines but this depends on how many characters are in your requestEnter exactly what you want embroidered. Example: FULL NAME (1st) WEIGHT & LENGTH (2nd) DOB (3rd). If none, enter N/A. NOTE: We will do our best to fulfil requests. However, there is a limited amount of space so we can not guarantee there will be room for your request.

Bear's Main Colorcolor preference

Choose a Different Color in case your First Choice is not availablecolor preference

Additional InformationEnter any additional information you want us to know including but not limited to: If your baby's first name includes more than one name (ex: Mary Beth). Your baby's story (if you want to share it with us). Etc.

Required waitlist fee *Up to 12 lbs (Waitlist Fee = $25 total)12lbs 1oz-17lbs 15oz (Waitlist Fee + extra expenses = $50 total)18lbs-30lbs (Waitlist Fee + extra expenses = $70 total)

Express Pass (If yes, you will also need to buy your own base bear from our Amazon Wishlist) *Yes (Add $40 Donation)NoReduce your time on the waitlist by choosing your own bear from our Amazon Wish List and sending it to us

Base BearI will buy my own base bear from your Amazon Wishlist

Base BearI will buy my own base bear from your Amazon WishlistChoose my base bear for me

Would you like to donate to Phoenix Bears? *Phoenix Bears is run solely on donations. Any donated amount over the expense of your custom bear will be donated to the next bereaved parent on the waitlist.

How did you find out about Phoenix Bears?

Receive Notifications?

Keep me updated with Phoenix Bears News!I'd like to learn more about Volunteer Opportunities

Total Charge

Discount

Applied 15% discount

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Total After Discount

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Applied 10% discount

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Note: Please fill in all the required (*) fields - once you do, the "Pay" button will appear below.

Calculations

DiscountFree Embroidery $7

Total After Discount