BE A PART OF THE HAPPINESS!

• REQUEST A BOX •

Request a Birthday in a Box for a child who is hospitalized on their birthday
(US hospitals only)

We require a minimum 10 days’ notice to assure our box will get to the recipient in a timely manner. All boxes ship from our headquarters in Rhode Island. If your hospital already participates with our program, please connect with your Child Life Specialist first, they have boxes on hand! A list of participating hospitals can be found here!

*Child Life Specialists & hospital staff, please do not fill out this form. Refer to your portal to request more birthday boxes

Child's Name

First Name

Last Name

Child's age they are turning

Child's Birthday

We CAN NOT honor requests more than 30 days BEFORE the child's birthday

YYYY

Desired Birthday Theme

Gender of Child

Which US hospital/facility are they admitted at?

child MUST be inpatient the day of their birthday or at clinic on their birthday

The child's hospital/clinic mailing address (room number MUST be included)

*Location can ONLY be a United States hospital/clinic/Hospice facility, if room number is NOT available we need the contact information of their Child Life Specialist. We CAN NOT send boxes to personal residences.

Your Name

First Name

Last Name

Your Email

Cell Phone Number

Cell phone number you can be text at on the day of the party

(###)

###

####

Your Relationship to Child (*parent, relative, grandparent)

*please NO hospital/facility staff

Is there a website/social page that provides updates on the child's progress? If so, please provide the link below:

please share an Instagram handle or Facebook page where you share your child's health journey

Does your Child have an Amazon Wish List started? Please provide the link below:

Share with us any details about this special birthday child!

Is there a special message from you that you would like us to include in the birthday box?

How did you hear of our mission?

Send me a Birthday box!

Filling out this form, I am aware I need 10 days BEFORE the child's birthday to get a custom box. (no more then 30 days before) If I do not have 10 days, I will check with my Child Life Specialist to see what Birthday Boxes they have on hand (if they are a participating hospital)

I agree that accepting this gift, I will provide photos/videos of our party!

Yes! I understand I need 10 days to receive a custom birthday box from The Confetti Foundation

Yes! my child will be inpatient or at their clinic receiving services the day of their birthday

Once form is reviewed, we will email you with any further questions and shipping details.

BE A PART OF THE HAPPINESS!

• REQUEST A BOX •

Request a Birthday in a Box for a child who is hospitalized on their birthday (US hospitals only)

*Child Life Specialists & hospital staff, please do not fill out this form. Refer to your portal to request more birthday boxes

Request a Birthday in a Box for a child who is hospitalized on their birthday
(US hospitals only)