who can
request?

do you or someone you know have a child with a tracheostomy?

Anyone can request a complimentary basket! Fill out the form below to send or receive a trach gift basket or email us at hello@s3kit.org to request more information.

request a basket

Currently, we are shipping anywhere in the contiguous United States.

Requester Information

First Name

Last Name

Phone

(###)

###

####

Is the child a girl or a boy?

Girl

Boy

How old is the child?

Please indicate years or months. For example, 4Y for 4 years old or 4M for 4 months old.

Do you know what size shirt/onesie the child wears?

For example: 9M, 2T, S/M/L

Does the child have a feeding tube?

When is the expected discharge date of the child?

We recommend gifting the basket within the month of the child's discharge date.

YYYY

What is the address the basket will be sent to?

Physical addresses only.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

If the address is a hospital, what is the name of the hospital?

What is the contact name for the address?

If English is not the primary language spoken in the home, please list language.

Anything else you want us to know?

Would you mind sharing how you heard about us?

who can request?

do you or someone you know have a child with a tracheostomy?

request a basket

who can
request?