Voucher Bears (hospital)

Voucher Number *Enter the voucher number listed on your voucher

Your First & Last Name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Email Address *

Phone Number (text) *Only used if we need to contact you and have no response from email

Baby's Full Name *

Baby's Weight *How much your bear will weigh

Theme, Color, or Pattern Request *A theme, color, or pattern you associate with your baby. We try our best to match at least one for you.

Name for Embroidered Belly Patch (1-2 names) *If you do not want a belly patch, enter: n/a

Embroidery Request for Blanket (1-3 short lines) *If you do not want emboirdery on your blanket, enter: n/a

Angel Wings *Do you want your bear to have angel wings?NoYes

Preferred Bear Color *what color bear would you prefer? We do our best but sometimes the requested color is not available.Tan or Light BrownMedium BrownDark Brown or BlackWhite or Off-WhiteGrayColorful (solid pink, blue, or yellow - or multi-colored)No preference - choose for me

2nd choice - Bear Color *If your 1st choice in unavilable, what is your 2nd choice? We will do our best but can't guarentee it will be available.Tan or Light BrownMedium BrownDark Brown or BlackWhite or Off-WhiteGrayColorful (solid pink, blue, or yellow - or multi-colored)No preference - choose for me

Additional notes0 / 180