HOSPITAL INFORMATION
 
 
 
 
 
 
 
 
 
Do you have a Child Life department?
Yes      No  
 
Number of in-patient beds
 
Number of pediatric out-patients per year
 
CHILD LIFE CONTACT INFORMATION
First Name
 
Last Name
 
Title
 
E-mail Address
 
Confirm E-mail Address
 
Phone Number
 
EXT.
Primary contact  
 
PUBLIC RELATION CONTACT INFORMATION
First Name
 
Last Name
 
Title
 
E-mail Address
 
Confirm E-mail Address
 
Phone Number
 
EXT.
Primary contact  
 
DONATION/FOUNDATION CONTACT INFORMATION
First Name
 
Last Name
 
Title
 
E-mail Address
 
Confirm E-mail Address
 
Phone Number
 
EXT.
Primary contact  
 
UPLOAD YOUR HOSPITAL'S LOGO
Yes, Spirit Halloween may use this logo on in-store signage
Note: File should be in one of the following formats:
A black and white EPS or AI. The file resolution should be 300 dpi and a minimum of 4" wide.
SETUP LOGIN INFORMATION
E-mail Address
 
Password
 
Confirm Password
 
Click here for Program Rules and Requirements.