Making kids smile…it’s what we do.

It’s more than just a toy…it’s a source of joy and a chance to choose.

This form should be utilized by authorized Kart 4 Kids Ambassadors.  Go4theGoal will do our best to fulfill all requests.  Questions at the end of the form are optional but will help us improve the Kart 4 Kids so we appreciate all your input!

Hospital Name *

Contact Name *

Email *

Phone *

Best Shipping Address *

Do you utilize a physical cart? *

• Yes
• No

What is your average number of in-patients per week? *

Please indicate if you need items for the below age ranges: *

• Infant/Toddler (0-2 years)
• Preschooler (2-5 years)
• Child (6-10 years)
• Pre-Teen (11-13 years)
• Teenager (14-18 years)

Please select categories of interest: *

• Arts & Crafts (ex: art kits, clay models, & nail art)
• Building Blocks
• Dolls & Action Figures
• Puzzles & Games (ex: card games & puzzles)
• Room Decor (ex: lights, wall & window art)
• Stress Relievers (ex: squeeze balls & fidgets)

We may not be able to fulfill all category requests, but we will use these to inform our restocking process for your unit and our future stock.

Do you want snacks? *

• Yes
• No

Do you want soft items (ex: stuffed animals, blankets, pillows)? *

• Yes
• No

Do you want electronics (ex: earbuds, speakers)? *

• Yes
• No

Do you want gift cards (for teenage patients ONLY) *

• No
• Apple
• GooglePlay
• Gaming (ex: PlayStation, Xbox)
• Shopping (ex: Target, Amazon)
• Uber/UberEats

Do you have any special requests?

Do you have any questions about the Kart 4 Kids?

Have you had any issues or problems with the Kart 4 Kids?

Please tell us if you've had any memorable moments with the Kart 4 Kids this month

We may use some stories on our social media to tell donors how they are making a difference to your patients but will never use any patient's name. Please let us know if your prefer that we do not share this story.

We're always looking for new items for the Kart 4 Kids. Please let us know if you or any of your patients have ideas!

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