Hospital Order Form

Hospital Order Form

Thank you for using the Second Stork online order form. This form allows us to insure accuracy and timeliness in supplying hospitals with critical care items for parents in need. Note: * indicates a required field. All order quantity boxes require completion (even if order quantity is "0"), then simply hit SUBMIT. A volunteer will be in touch soon regarding your delivery.

Please note when selecting the delivery method, you can choose to have your order ,picked up at our warehouse 24/7 at Riverview Business Plaza, 284 Chester Street in Saint Paul by finding a co-worker or community volunteer to pick up your order. In this case, our volunteers can have your order ready generally within 72 hours. If you would like Second Stork to find a delivery volunteer, it can take us a bit of time - usually up to two weeks within the seven-county metro area and possibly as long as a month in other areas. If you have any questions, please contact us at deliveries@secondstork.org

Items Requested

(Insert quantities. All fields required.)

Diaper Bags of 100 diapers, wet wipes, and related items

For parents with limited or no financial resources to secure a supply of diapers and wet wipes for their newborn's first few weeks. Specify the quantity of sizes you prefer below.  Total number of bags may not exceed 20.
For babies under 5 lbs
For babies 5-8 lbs
For 8 lb and larger babies

Clothing sets include one t-shirt, one sleeper, one receiving blanket, and a cap.

For parents with no clothing for their newborn as they leave the hospital. Supply is limited and most hospitals report that typically the number of parents that have no newborn clothing is less than half the number that need diapers. Specify the quantity of sizes you prefer below. Total number of sets may not exceed 6.
Generally for babies under 5 lbs
Generally for 5-8 lb babies
Generally for 8 lb and larger babies

For hospital staff to keep on hand to distribute as they deem appropriate. Maximum of 2.
For hospital staff to keep on hand to distribute as they deem appropriate. Maximum of 2.
Quantities are very limited. Please order only the number that corresponds to parents that would have NO other option or resource to secure a safe place for their newborn to sleep. Based on our past order history with hospitals across the region we serve, the number of parents in this situation is MUCH smaller than the number of parents that cannot afford diapers and appreciate the bag of 100 diapers. Maximum of 5.
For hospital staff to keep on hand to distribute as they deem appropriate. Same as the English book included in every diaper supply bag, but written in Spanish. Comes in sets of 2 books each with a brochure. Maximum of 6 sets.
If you have additional information regarding this order for Second Stork, please note above.

Delivery

Delivery can take 2-4 weeks - please see note on top of page.
Second Stork strives to have Pick Up orders available when requested, however, please wait for the 'Order is Ready for Pick Up' email before proceeding to the warehouse.
Pick Up Time
The hospital representative's name picking up the order at the warehouse
A phone number for the hospital representative picking up the order at the warehouse
NOTE: Hospitals outside of metro area may need to make accommodations for weekend or evening drop-offs

Contact Information

Contact information about this order
Please enter a phone number should Second Stork need to contact you about this order.
Please enter an alternate mobile phone number.

Confirmation

Mission Confirmation 1
Second Storks' mission is to provide families in need with essential newborn care items to give their baby a safe and healthy start. Second Stork relies on social workers and nurses to determine when a family does not have the means to secure the essential items to care for their newborn upon discharge and to only give to the family the items that they lack. Items are given to families as packaged by Second Stork.Please check here to confirm that your hospital is fully consistent with this Second Stork mission.
Mission Confirmation 2
Central to Second Stork's mission is that all items are distributed to families in need without regard to race, gender, ethnicity, nationality, religion, sexual identity, familial status, age, disability, and socio-economic status. Please check here to confirm that your hospital is fully consistent with this second Stork mission.
This order form cannot be submitted unless both statements are confirmed. If you cannot confirm the hospital's adherence to both statements, please contact outreach@secondstork.org for assistance.
Sending
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  651-272-0356
   284 Chester Street
Riverview Business Plaza
St. Paul, MN 55107