Angel Gown & Keepsakes Request Form
Angel Babies of Wisconsin provides handmade burial gowns at no cost for stillborn and infant loss.This form is for funeral homes, hospitals, hospices, and care organizations to request gowns for families in need.
Organization Information
Organization Type
*
Birthing Center
Hospice
Hospital
Funeral Home
Other
Organization Name
*
Contact Person's Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
The above information is the same as my mailing information
Yes
No
Angel Gown Needs
Do you currently have angel gowns available?
*
Yes
No
Estimated number of families served annually (optional)
Style Preferences
*
Traditional
Sleeper/Wrap
No Preference
Other
Size & Quantity of Gowns Requested
*
Rows
Qty
Micro-Preemie / Angel Pods (babies weighing up to 1 pound)
Preemie (babies weighing 1 to 3 pounds)
Small / Medium (babies weighing 3 to 6 pounds)
Infant / Newborn (babies weighing 6 to 9 pounds)
Newborn (babies weighing more than 9 pounds)
Hats Requested
*
Rows
Qty
Micro-Preemie / Angel Pods
~ 4” to 6” head circumference; about 2.5” tall.
Preemie
~ 7” to 8” head circumference; about 3” to 3.5” tall.
Small / Medium
~ 9” to 11” head circumference; about 4” tall.
Infant / Newborn
~ 11” to 13” head circumference; about 4.5” to 5.5” tall.
Blankets Requested
*
Rows
Qty
Size A ~ 22" x 22"
Size B ~ 24" x 26"
Size C ~ 28" x 30"
Date Gowns & Keepsakes Needed By
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Delivery / Pickup
Preferred Method
*
Ship to Organization
Pickup by Organization
Delivery by Angel Babies (If Available)
Other
Shipping / Delivery Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Special Requests
List Any Special Requests Here
Confirmation
I understand that gowns are provided at no cost and availability may vary.
*
Yes
No
Submit Gown Request
Should be Empty: