Free W.H.A.L.E. Kit Order Form

Free W.H.A.L.E. Kit Order Form

In 2021, 162,298 children were injured in automobile crashes. These crashes happen when children ride with parents, grandparents, or other caregivers. If the adult in the vehicle is seriously injured and unable to talk, emergency personnel have no easy way to identify the child or his/her special needs-vital information. Sometimes, just knowing the child’s name can help rescue workers comfort a frightened child. That’s when W.H.A.L.E. – “We Have A Little Emergency” can make a difference.
A kit consists of:
- 1 - Car seat information label/sticker
- 2 - Car seat label/sticker
- 2 - W.H.A.L.E. Window cling
- 1 - Trifold
- 1 - One pager
NOTE: Limit five (5) free kit per organization.
Name

First NameLast Name
Address*

Organization (REQUIRED)

Address

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Please contact pediatrics@txena.org with any questions.
Should be Empty: