Turtle-Gram Request Form Webform February 14, 2019 Camper's First Name: * Camper's Last Name: * Your email: * First: * Last: * Child's Age: * Where would you like the Turtle Gram delivered? Street Address: * Address Line 2: If hospital, please provide the room # in the space above. City: * State / Province / Region: * Zip / Postal Code: * When would you like the Turtle Gram to arrive?: * As soon as possible Other If you would like the Turtle-Gram to arrive by a certain date, please choose “Other” and specify the date (mm/dd/yyyy) in the field that appears. Please specify: When was the last time your child was at The Painted Turtle?: * Will your child be hospitalized, having a medical procedure, and/or on bed rest for 3 or more days?: * Yes No If no, please tell us why you think they would benefit from a Turtle Gram.: Would your child be interested in a virtual visit with members from The Painted Turtle team?: * Yes No What was your child's favorite part of camp?: Is there anything else you'd like us to know for the Turtle-Gram?:
