General Information Location of Medical FacilityPlease select... United States Canada China Israel Medical Facility Name (as listed on your website) Department/Unit/Clinic Street Address to receive donations (i.e. 100 Sunshine Lane, Room 604) Any additional directions (i.e. attention child life, room 402) City StatePlease select... AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code We want to be mindful of your medical facility and departmental restrictions so please indicate if there are any specific restrictions we should be aware of. Please note that all of our donation/activities are latex free. Primary Contact Person Primary Contact: First Name Primary Contact: Last Name Primary Contact: Title Best Phone Number to Contact you Phone typePlease select... Office Mobile Primary Contact: Email Have you worked with Project Sunshine prior to working at your current medical facility?YesNo Alternate Contact Person Alternate Contact: First Name Alternate Contact: Last Name Alternate Contact:Title Alternate Contact: Email Best Phone Number to Contact you Phone typePlease select... Office Mobile Patient Demographic Information Number of children receiving care on your unit/clinic Which of the following conditions affect a significant percentage of patients in YOUR unit/clinic? Select all that apply.Mental/behavioral healthCancerCardiacLimited mobilityRespiratorySensory IssuesOther (list below) Other conditions The majority of our written materials are in English and Spanish. For future reference, which additional languages would be most helpful for your patients? What percentage of the pediatric patient population in your unit/clinic would you consider to be underserved and/or have limited access to resources?0-25%25-50%50-75%75-100% Sending Sunshine Items Please note that the below requests are subject to the availability of Project Sunshine materials based on the number of hospital partners at any given time. We will try to accommodate your program and shipping requests. Each shipment contains 100 kits of the same type. For more information about these kits, you can view them in more detail here. Please check off any of the Sending Sunshine items you are interested in receiving. PuppetCrownSuperheroBasketballSTEMCaregiverBuildingScrapbookSensoryMandala (Mental/Behavioral Health)Surgi Dolls Project Sunshine recognizes the storage challenges our medical partners face so please indicate the number of items you would like to receive in each shipment. The exact number may vary depending on availability.Please select... Up to 100 Up to 200 Up to 300 Up to 400 Up to 500 n/a (I do not wish to receive Sending Sunshine items) Would you accept Surgi Dolls that are asymmetrical, or sewn by less experienced volunteers?YesNo If yes, is there a limit to how many you can accept? Project Sunshine In-hospital Volunteer Programming Please check any in-hospital volunteer programs that interest you when hospital infection control permits. Please keep in mind the below programs are subject to availability of volunteer groups in your area. Arts and CraftsCaregiver WellnessParty TimeI do not wish to receive in-hospital volunteer programming For more information about our in-hospital volunteer programs, you can view them in more detail here. Project Sunshine also partners with corporations to support special events. Would your facility be interested in volunteers/support for special events?YesNoMaybe How many volunteers can you accommodate for a special event? Project Sunshine TelePlay Program Project Sunshine's TelePlay program is a live, virtual play experience, using a HIPAA compliant technology platform that mirrors our in-hospital volunteer-based programming by providing developmentally appropriate, engaging activities and games. . Please check which model of TelePlay your hospital would like to participate in:Chapter TelePlay: TelePlay co-led by the Hospital Partner and Project Sunshine's highly trained and vetted volunteers.National TelePlay: TelePlay led by Project Sunshine's highly trianed and vetted volunteers, including skilled volunteers like artists and musicians, and is open for any child/family facing medial challenges either in or out of the hospital.We do not wish to participate in Project Sunshine Teleplay Do your patients have access to technology devices either personal or hospital provided?Personal Hospital Provided Which of the following devices do they have access to?Smart PhoneTabletLaptop Marketing and Social Media Consent Does your facility allow third-party consented photos to be taken at a program?YesNoUnsure If known, please provide the best contact at the medical facility for questions related to volunteer management processes (Name, Title, Department, Email, and Phone Number). If known, please provide the best contact at the medical facility for questions related to marketing, communications and/or social media consent (Name, Title, Department, Email, and Phone Number). If known, please provide the best contact at the medical facility for questions related to development and/or external relations (Name, Title, Department, Email, and Phone Number). Additional Comments Please include any comments or questions you have for Project Sunshine. Contact Information