Barrett’s Bear Request Form

Bear Request Application

Please read all instructions in full!
***Please note, we have a set policy of ONE donated bear per family.

If you have had more than one loss (or would like addtional shirts) there are a few options:

1) When prompted in this form, you will have the option of purchasing up to 3 additional shirts.

2) You can put 2 short names on the same shirt that comes with bear. (Please read our FAQs found on our website for more detailed information.)

3) If you or a family already have received a Barrett’s Bear, but would like a shirt(s) only to use on a bear you have, you can go to our Teddy Bear Shirt Order Form.

If you have any questions about any of our rules & policies, please see our Frequently Asked Questions.

*If there are duplicates filled out to attempt to receive multiple bears for the same baby or family, we unfortunately will not be able to fulfill the request. There will be no refunds for application fee.

Thank you for your understanding, as we are trying to reach many families and want them each to be able to recieve a bear. This requires us to be responsible with the funds that are donated to us.

SHIPPING & TRACKING

*You will receive tracking info for the bear you are sending through the email you provide in this form.*

Due to high demand of requests and the nature of how the shirts are made, we must send designs in bulk to be printed and pressed 1-2 times a month. Following this, we still have many things to do in order to assemble bears and get ready to be boxed and shipped.

Please be informed that it may take 4-8 weeks before receiving tracking info. (It usually is not this long, but be prepared just in case we have an increased amount of requests at the time.)
SHIPPING LOCATION: Where will your bear be shipped to? (Application fee helps with SHIPPING ONLY. This fee is not for the bear or supplies)

REQUESTER'S INFORMATION

Person filling out this form
What is your full name?
Name of person filling this out
Email

Confirmation EmailPlease add working email. This is where you will receive tracking. You are responsible for tracking package.
How did you hear about Barrett’s Bears Ministry?
Friend or family member, Facebook or Facebook group, etc?If it was a Facebook group or page, please include the group or page NAME.
What is your relationship to the grieving parent(s) who will be receiving this bear? (Just put “self” if you are the parent filling this out 🙏🏻)
If you are the parent, just put "self"
Would you like for the recipient to know you requested the bear? Or remain anonymous?

Other
Please provide the best way for me to contact you if I need to. (Phone or email?)

PARENT AND BABY INFORMATION
What are the parent(s) name(s)? Give first and last name(s).
Parent(s) names
What is the baby's gender? This is the color shirt that will be on bear.
What is the baby’s full name? (First, middle, and last to be placed on bear shirt).
- If the parents were not able to name the baby before they passed please specify what last name needs to go on shirt . (Ex: Baby Smith)
- OR whatever name you would like on the shirt (Ex: Nickname)
- Please be advised if you are requesting two names on the same shirt or name is very long, there is a limit to the amount of characters we can print on one line on the shirt. I would suggest using something like the following examples (Ex: Michael and Benjamin Smith or Smith Twins or Smith Babies).
**What you write in the blank is exactly how the name with appear on shirt.
What is the baby’s full name?
Baby's name that will fill in the blank: "In loving memory of __________"
How did the baby pass away? (optional; answer not required)

Other
How old was baby when he or she passed? (If early miscarriage, how far along was mom?) (optional; answer not required)

Extra Shirts for Additional Charge:

1 shirt=8.00 -- 2 shirts=14.00 -- 3 shirts=20.00
NOTE: Each bear requested already comes with an original shirt on the bear. This section is referring to OPTIONAL EXTRA shirt(s) that you can purchase for an additional fee.

OPTIONAL SHIRT ORDERS:
- You can purchase up to 3 additional shirts
- Purchased teddy bear shirt(s) have the same design. The names and colors (blue, pink, white) can different.
- The name on the purchased shirts can be duplicates of the bear being requested in this form.
- Purchased shirts can be for different babies (mulitple losses, etc) with different names. Just make sure if you are purchasing more than one shirt for different babies, that you specify the names and colors required for each.
Purchasing extra shirts allows you to use them for a teddy bear you buy or own already. (16 inch teddy bears work best).

For further details about this topic, you can visit our website and search in FAQs.
Would you like to purchase an additional teddy bear shirt for an additional fee?
Additional teddy bear shirt(s):
If the name/names will be different on the shirts you're purchasing, please include below. Click "Add Row" for each additional name and/or color. If the name is the same is name in the application, leave blank and continue to NEXT section.

Mailing Info for bear to be shipped:

Please double check all names and addresses for spelling error before submitting.
SHIPPING INFO
- Please double check ALL shipping information for ANY errors prior to submitting form.
- If there are ANY errors, this may prevent the package from reaching the family.
TRACKING INFO

*You will receive tracking info for the bear you are sending through the email you provide in this form.

Due to high demand of requests, please be informed that it may take 4-8 weeks before receiving tracking info. (It usually is not this long, but be prepared just in case we have an increased amount of requests at the time.)
Resident's Name

First NameLast Name
Recipient's Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I agree that this bear is being shipped directly to the parent(s) or to the requestor of this form. (If other, please provide reason)

Other
I understand I am responsible for tracking package through the correct email that I provided on this form. Barrett's Bears is not responsible for mailing errors due to incorrect mailing address given or due to Post Office errors. I, the requestor of this form, am responsible for calling or communicating with post office if any issues arise in delivery errors.

Submission Page
*OPTIONAL DONATION*

The cost of one Barrett Bear per family is approximately $30-35 dollars. *Prices are always changing, but the ministry pays this amount for supplies alone for one bear. (This does not include operations, softwares, machines, printers, etc)

*The Application fee required to submit this request goes towards ASSISTING with shipping and handling. Depending on destination, it may not even cover shipping rates fully.

Although not a requirement, the Ministry is entirely dependent on donations and 100% goes towards all the ministry's operation needs and it continues to help us provide these bears and the resources needed. 🙏🏻

Adding a donation of any amount is helpful to our cause!
If you would like to add a optional donation today, please enter number value only. Otherwise, leave the box blank. Thank you!
number value only. No decimals, letters, or special characters.
Totals: *submission fee, additional shirts added, added donations. (*submisson fee is the only required payment. Other fields are optional and added by submitter.)

Total:

USD*Submission fee (required) +optional shirt(s) + optional donation

Payment Methods
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Unique Code
Is there anything else you'd like to let me know or pray about?
If you need to contact me for any reason our email address is Barrettbearministry@gmail.com or FB messenger through Barretts's Bears page.

**Our website can be found at barrettsbearsministry.com and you can support us by donating towards our cause here as well! **

*Please email/message me if you do not receive a confirmation email that this form was submitted.** Thank you and God Bless. 🙏🏻
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Bear Request Application

REQUESTER'S INFORMATION

PARENT AND BABY INFORMATION

Extra Shirts for Additional Charge:

Mailing Info for bear to be shipped:

Submission Page

Total:*

Total: