Donation Scheduling

Contact Person:*

First NameLast Name
Name of Group/Organization:
Email:*
example@example.com
Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*
Fax Number:
Contact Preference (NOTE: Scheduling confirmation and reminder information will be sent through email regardless so information can be kept on hand until needed):*

EmailPhone

Does your organization have social media pages that Wesley Children's Hospital and/or its affiliate organizations can tag in any posts made from our marketing department? (Personal social media pages CANNOT be used!)

Wesley Children's Hospital is a for-profit facility that is required to follow compliance and legal regulations set for this type of facility. The below requirements are in place to ensure these regulations are met and that our facility stays in good standing. If you have questions about any of the below requirements, please don't hesitate to reach out to our team!
REQUIREMENTS FOR ALL DROP OFFS

IF ANY OF THE BELOW REQUIREMENTS ARE NOT MET, WE WILL NOT BE ABLE TO ACCEPT YOUR DROP OFF.
1. EACH INDIVIDUAL ITEM must have a sticker/label with the group/organization's name or logo on them (printed label, sticker, etc.). This ensures families know who provided the item and that it did not come directly from the hospital.
2. Labels CANNOT include any type of promotion (ex. $5 off a purchase, contact for business needs, etc.). They may include your logo and a statement of "This item was donated by ....."
3. If you are planning a donation drive of any type, you are NOT able to advertise that is a drive for Wesley Children's Hospital specifically, as we are not directly asking for these items. We suggest using phrases such as "for locally hospitalized kids" or "kids in need in the community."
4. All items must be unwrapped!
5. All items must be new and in original packaging.
6. We serve patients 0-18, so any gifts for all ages are much appreciated!
7. Although recreation items (ex. Bikes, scooters, etc.) are fun for children to play with, these are not items we can hand out as a hospital due to safety risks. We are unable to accept these as part of any drop-off.
8. Because we serve a diverse population of patients, we are unable to pass out anything promoting specific religions/beliefs (no specific images, verses, etc. should be included on or in donated items).
9. We are unable to accept any items that are intended to stay in the hospital for repeated use. Items that are donated will be sent home with patients as deemed necessary by the Child Life team.
SEE EXAMPLES OF LABELS BELOW
ALL ITEMS PROVIDED WILL BE PASSED ON TO PATIENTS AND FAMILIES RECEIVING CARE.

WE ARE UNABLE TO ACCEPT ANY ITEMS INTENDED TO STAY AT OUR FACILITY TO BE REUSED.
I have read the above requirements and understand if these are not met, I will not be able to drop off my items.*

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**PLEASE REMEMBER NO LATEX MAY BE BROUGHT INTO THE HOSPITAL, INCLUDING BALLOONS!**

We discourage providing food items to patients, as many have dietary restrictions.

For questions, contact the Child Life Office at 316-962-2177.
Please describe what your group plans to donate.*
Amount of items you plan to bring so staff can arrange for ample organizational space and transport to the units.*
When dropping off your items, what make, model, and color of vehicle will you be driving?*

We work to schedule all drop-offs between 10:00 am and 4:00 pm, Monday through Friday.

Alternate arrangements may be possible depending on staffing availability, but this cannot be guaranteed.

Because our calendar fills up quickly, we ask that you provide alternate dates as well. Scheduling is done on a first-come, first-served basis.
PREFERRED DATE OF DROP OFF*

MonthDayYear
Date
Alternate Date 1*

MonthDayYear
Date
Alternate Date 2

MonthDayYear
Date
Alternate Date 3

MonthDayYear
Date
Preferred time of day (SELECT ALL AVAILABLE OPTIONS)*

Morning (10:00 am - 12:00 pm)Afternoon (12:00 pm - 4:00 pm)Other
Selecting a date on this form does not guarantee that this date will be available!

Once your application is reviewed and approved by our staff, you will hear from us to set a specific time and date for your visit.

I verify that all of the information provided is accurate:*

Yes
I understand the rules and guidelines for drop offs, and agree to adhere to these guidelines when assembling items.*

Yes
I understand that the hospital staff maintains a schedule centered around patient care, and I agree to arrive on my scheduled date and time. Early or late arrivals may be rescheduled if alternate arrangements were not made in advance.*

Yes
I confirm that I am a representative of the above-mentioned group. I have reviewed these requirements and affirm my group’s willingness to adhere to all of the guidelines. By signing below, you are agreeing to the above statement and are acknowledging that you are responsible for all members of your group while on property.*

Clear
Please verify that you are human.*
Should be Empty: