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399d8pSJdHASgaLu7U7eZUhjhgk4Pv9aA99

Heart Center Support Programs Donor Information Form

Please fill out this form to give the Kids at Heart and the Heart Center Support Programs Teams a little more information regarding your donation.

PLEASE NOTE - DUE TO THE MOVE TO ARTHUR M BLANK HOSPITAL ON SEPTEMBER 29, WE WILL STOP TAKING DONATIONS ON AUGUST 1ST SO WE CAN PREPARE FOR THE MOVE. DONATIONS AND MEALS WILL START AGAIN IN NOVEMBER AT THE NEW HOSPITAL. I

If you'd like to bring a STAFF treat or meal to Egleston before closing, you can fill out this form and someone will be in touch!

Please note:

The Heart Center Support Programs team is not always at Egleston. You must give AT LEAST a week's notice if you would like a team member to meet you to obtain your donation. Email us at kidsatheart@choa.org if you have a special circumstance. Thank you!

The Heart Center CANNOT accept donations on evenings or on Fridays, Saturdays or Sundays. We do not have the staff at the hospital during those hours/on those days and we cannot ask our clinical staff to step away from the units to handle donations. Thank you for understanding! If you have a special circumstance you may email us at kidsatheart@choa.org

Thank you for supporting the Heart Center!

Today's Date:

* must provide value

M-D-Y

Your First Name

* must provide value

Your Last Name

* must provide value

Donor Name

Company Name/Organization Name/Community Group Name, etc.

Address

* must provide value

City

* must provide value

State

* must provide value

Zipcode

* must provide value

Phone Number

* must provide value

Are you a parent or family member of one of our Heart center patients?

* must provide value

Yes

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If No, how did you find out about supporting the Heart Center and its programs?

What is your preferred delivery date? PLEASE NOTE WE NEED AT LEAST ONE WEEK'S NOTICE TO SCHEDULE DONATIONS AND CANNOT ACCEPT DELIVERIES ON EVENINGS OR ON FRIDAYS, SATURDAYS OR SUNDAYS. If you have a special circumstance please email us at kidsatheart@choa.org.

* must provide value

D-M-Y

If you see this message, please update your delivery date to MONDAY-THURSDAY

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Please note, The Heart Center Support Programs team is not always at Egleston. You must give AT LEAST a week's notice if you would like a team member to meet you to obtain your donation so we can make sure we have availability. Please acknowledge below that you have chosen a date with at least a week's notice or that you do not need a team member to meet you and will drop the delivery at the front desk of Egleston.

Email us at kidsatheart@choa.org if you have a special circumstance. Thank you!

* must provide value

I have chosen a date that give at least a week's notice to the Heart Center Support Programs Team.

I do not need a team member to meet me and will drop off my donation at the front desk at Egleston and I will label my donation with the names Alison Mueller/Kalli Lamkin.

N/A

What is your preferred delivery time? If you need a staff member to meet you, please try to come as close to the time you have selected as our staff members will block off their calendars and make sure they are at Egleston to meet you. Someone will follow up a few days before your delivery to give additional details.

* must provide value

Morning (9:00-10:00 AM)

Morning, (10:00-11:00 AM)

Mid-Day (11:00 AM - 12:00 PM)

Mid-Day (12:00-1:00 PM)

Afternoon (1:00 PM - 2:00 PM)

Afternoon (2:00-3:00 PM)

Afternoon (3:00-4:00 PM)

Evening (5:00-6:30 PM) - this choice is only for Feed the Heart meals

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Is this donation:
In Honor of a Heart Warrior?
In Memory of a Heart Warrior?
In Honor or Memory of a friend or loved one?
In celebration of a Heartiversary?
In celebration of a Birthday?
From your company/group/organization?
Please describe:

* must provide value

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What are you donating?

* must provide value

Feed the Heart pantry items

Feed the Heart meal (Served on Tuesday evenings)

Feed the Mind Newborn Brain Health items (Board Books/Infant toys)

Feed the Mom Postpartum support program items

Other toys, games, stuffed animals, art, etc for patients

Care Packages /Toiletry/Comfort items for parents/ caregivers/patients

Meals/Snacks for staff

Check/ money

Other

For "Feed the Heart pantry items," please describe the items you will be or have/collected. Please be sure to check with Heart Center staff on needed items before you collect. Please label your items with month and year of their expiration date.

Wish List of Food Items for Pantry Donations:

Please note all food items must be store-bought, pre-packed, non-perishable, and microwaveable. Please be mindful of expiration dates as we are unable to use expired items.

Please label your donations with the month and year of the expiration date, if possible.

o Bottled water
o Canned soft drinks
o Canned or plastic bottles of iced tea, lemonade, sparkling water
o Individual plastic bottles of juice - NO juice boxes please; NO SUNNY D
o Single serving cups of macaroni and cheese, soup, pasta, ramen noodles or stew (microwaveable)
o Breakfast bars and granola bars
o Individually packaged peanut butter or cheese crackers
o Single serving bags of chips, pretzels, cookies or crackers
o Single servings of instant oatmeal or grits
o Fruit or applesauce cups
o Individually packaged breakfast pastries, muffins, donuts or pop tarts
o Individual boxes of cereal
o Snack sized candy bars
o Coffee K cups

* must provide value

Please note, we are unable to accept donations larger than a trunkful / back of mid-sized SUV. We unfortunately do not have the storage for extremely large donations. Donations need to fit on two standard-sized utility carts. If you have already collected items and have a larger donation, we may ask you to bring the donations at two separate times. Email us at kidsatheart@choa.org and we can discuss options. Please acknowledge that you have read and understood this information. Thanks for your understanding!

* must provide value

I understand that I need to limit the size of my donation due to storage space.

There are three different options for how you can provide a meal. Please read these options carefully and choose the option that works best for you. FIRST, please choose a date listed on our sign up genius here: https://www.signupgenius.com/go/20f054ba5ab2ca3fa7-feed2.

I will donate the money to pay for a meal ($1000 minimum) and the Feed the Heart Coordinator will order the food from a pre-approved vendor and make all delivery arrangements.

I will contact a restaurant of my choice directly and pay the restaurant directly. The Feed the Heart Coordinator will make delivery arrangements.

I will contact a restaurant of my choice directly and pay the restaurant directly. I will deliver it myself or make delivery arrangements myself and communicate those arrangements to the Feed the Heart coordinator.

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If you chose that you will donate the money to pay for a meal please use this link to donate the funds. Feed the Heart meals cost a mimium of $1000 dollars. This link will also be emailed to you. Thank you!

https://www.choa.org/medical-services/heart-center/support

Please acknowledge that you have read this statement.

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I have read this statement and will donate the funds at the link above.

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If you are sponsoring a Feed the Heart Meal, let us know if you'd like to come in person for photos and/or to help deliver meals room to room upstairs. Adults and children ages 2 and older can assist with handing out meals on our CACUs. (CICU is limited to staff). NO MORE than FOUR people may come at one time.

* must provide value

I would like to take photos outside/in the lobby of Egleston with the meal delivery but do not wish to come upstairs to help deliver the meals

The ADULTS sponsoring this meal would like to take photos and help deliver the meals room to room upstairs. (MAX of four people, masks required)

The FAMILY sponsoring this meal would like to take photos and help deliver the meals room to room upstairs. The children in attendance will be two and older. (MAX of four people)

I will not be in attendance in person to take photos/deliver meals but will upload my family/group/organization photo in a later field.

If you are donating a "Feed the Heart meal," and ordering the meal yourself please describe type of meal you are providing.

How would you like this meal acknowledged on the unit? Example: "Provided by the Smith Family in Honor of John's 2nd Birthday" or "Provided by Acme Company"

If you are providing a Feed the Heart meal, please note, we cannot also accept large donations on the same night of a Feed the Heart meal. You are welcome to bring a standard wagon sized donation. If you have in-kind donations you have graciously collected and you'd like to bring to the hospital, we ask you do this at a separate time. Thank you for understanding. Please acknowledge this message.

* must provide value

I understand that large donations cannot be accepted the same night as Feed the Heart meals.

If you'd like, please upload a picture of your warrior/ family/group/company/logo to be used on the Feed the Heart signs or for us to post on in our Facebook group/profile (@kidsatheart choa) to thank you for your donation.

Upload file

If you'd like to add another picture, attach it here.

Upload file

If you would like to share, we'd love to know a little bit more about your donation!

If you are a heart family, please share a little bit about your heart child's and family's journey! This information may also be included in a Kids at Heart newsletter. Anything that you'd like to let us know about your heart child that his/her care team would love to see as far as where your Heart child is now?

If this is an in memoriam gift, please let us know anything about your loved one that you'd like to us to share in their honor and memory.

If you are related to/friend of a heart family, please share why you are donating.

If you are a company/community group/organization, please share why you chose to donate.

Thank you!

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Are you okay if we use the photo you provided and/or photos we take of you/your family/your child/your donation to post on our social media groups and pages?

* must provide value

Yes, feel free to post the photos

No thank you!

For Feed the Mind Newborn Brain Health items (Board Books/Infant toys) please describe:

* must provide value

For Feed the Mom Postpartum support program items please describe:

* must provide value

For Other toys, games, stuffed animals, art, etc for patients please describe:

For "comfort items," for parents/caregivers please describe:

For Meals/Snacks for staff please describe:

For "check/money," please indicate dollar amount of donation:

For "other," please describe:

Please describe the size of your donation so we have the right amount of carts to help you unload. We cannot accept extremely large donations. Does your donation fit in a typical trunk/back of mid-sized SUV? Are there heavy items, like cases of bottled water? If this does not pertain to you, please write N/A.

* must provide value

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Please upload a photo of the items you are donating (optional)

Upload file

Any other questions or comments?

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