Other Pediatric Applications


** Applications must be submitted by a member of the patient's hospice or palliative Care Team
** Note: We do not provide reimbursement for payments already made or items previously purchased.

Before completing one of the following gift request forms please read the guidelines below by clicking the purple button.
If you have access to Docusign, it may be used to obtain the required signatures. However, the instructions below MUST be followed! You can find the instructions by clicking the purple box titled "Docusign Instructions."

Fingerprint Charm
Request

Please follow the steps below to submit a Charm Request.

1. Please download and complete the form below by clicking the purple button. 

2.  Once all the required information is obtained. Please submit the form by emailing it in pdf form to info@hpcfoundation.org

3. Please let us know your thoughts!

Photography
Request

Please follow the steps below to submit a Photography Request.

1. The Patient and their Photographer of Choice must complete the following form. After the form is completed, the Hospice Care Worker must sign before it is submitted.

** There are additional forms the photographer needs to fill out below!

2.  Once all the required information is obtained. Please submit the form by emailing it in pdf form to info@hpcfoundation.org

3. Please let us know your thoughts!

The Photographer MUST complete the following forms:

1. Photography Program Package Voucher Payment Form

2. Direct Deposit Agreement for Photographer

BONUS: Photography Session Tips for the Photographer

Holiday Gift Request
(November 1st - December 20th)

Please follow the steps below to submit a Holiday Gift Request (October - December ONLY)

1. Please download and complete the form below by clicking the purple button. 

Holiday Gift Request (Nov 1st - Dec 20th)

2.  Once all the required information is obtained. Please submit the form by emailing it in pdf form to info@hpcfoundation.org

3. Please let us know your thoughts!