Weighted Bears Order Form – Healing Embrace

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Weighted Bears

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This Weighted Bear is requested for *

Myself Someone I know

Baby's Name (if known) *

Baby's birthdate *

Pounds *

If weight is unknown, please enter "unknown"

Ounces *

If weight is unknown, please enter "unknown"

Sex of Baby (if known) *

Male Female Unknown

Bear Color Preference *

Brown (10 pound max) Cream (13 pound max) No Preference

Ribbon Color? *

Pink Blue Neutral

Recipient's First Name(s) *

Recipient's Last Name *

Who will the bear be shipped to? *

Ship to the recipient Ship to me

Shipping Address

Address Line 1: *

Address Line 2:

City *

State/Province *

Zip/Postal Code *

Country *

Phone Number *

Use shipping address for billing? *

Yes No

Recipient's Story *

Email Address *

How did you hear about us? *

(*) Denotes a required. Must be filled out to submit form.

While we do our best to fill orders in a timely manner and try to help fill urgent needs quickly, please allow 4-6 weeks for delivery. *

I understand

Choose Bear or Care Package Only *

Add Care Package for $20+ tax?

Add Care Package to this order for additional $20 + 7% tax

If adding a care package, are there other children at home and what age(s)?

If adding a care package, should we include something for dad or siblings?

Yes, Both

Yes, Dad

Yes, Siblings

Add additional donation?

Free local pickup available in Omaha NE? *

Yes

No (adds $20 shipping to US only)

Payment *

Total:

Questions? Please email healingembrace@griefsjourney.org or call Sandy at (402) 502-2773

Thank you so much!